Severe Aortic Regurgitation, Aortic Valve Preserving Procedures: A Viable Alternative to Prosthetic AVR

reoperative cardiac surgery: frequency, characterization, and rescue. J Thorac Cardiovasc Surg 2008;135:316–23, e316. [2] Khan N, Yonan N. Does preoperative computed tomography reduce the risks associatedwith re-do cardiac surgery? Interac CardioVasc Thorac Surg 2009;9:119–23. http://dx.doi.org/10.1016/j.hlc.2013.03.019 Monday 12 November – Session 2/1700 – 1710 Severe Aortic Regurgitation, Aortic Valve Preserving Procedures: A Viable Alternative to Prosthetic AVR Pallav Shah1, Sudhir Wahi 2, Arnold Ng2, William Wang2, Terri hall 2, Alasdair Watson1,∗, Paul Peters 1 1Department of Cardiothoracic, Princess Alexandra Hospital, Brisbane, Australia 2 Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia Introduction:This studywas undertaken to examine the clinical and echocardiographic outcomes following aortic valve preserving procedures (AVPP: Valve sparing root and Primary valve repair). Methods: Forty-six patients were operated during the study period September 2008 to September 2012. Valve sparing root: 25/46 (54%) patients [Grade of AR: Trivial to mild – 15/25 (60%); Type: Reimplantation-24, Remodelling-1; Valve: Tricuspid-24, Bicuspid-1; Aetiology: Rootdilation (Ib, 2marfans)-20,TypeAdissection5]. 13/25 (52%) had associated cusp prolapse repair. Primary repair: 21/46 (46%) patients [Grade of AR: Severe-16/21 (76%); Valve: Tricuspid-6 (Type Ic-2, Type II4), Quadricuspid-1(Type II), Bicuspid type 1 (with raphe)-7 (Type Ic: 1, TypeII-5, Type III-1), Type A dissection: 7]. Associated elective procedures were CABG: 9 and Hemiarch: 6. Preoperative investigations included 2D and 3D TTE, TOE and Cardiac CT in all patients. Cardiac CT scan proved more accurate in annular and sinus diameters as compared to TOE. (El Khoury classification*; Type I: normal cusp motion [Ia: ascending aortic aneurysm, Ib: aortic root aneurysm, Ic: annular dilation]; Type II: cusp prolapse; Type III: restrictive cusp motion). Results: Thirty-day-mortality: 1/46 (2.2%, redo aortic dissection); Late mortality: 1/45 (2.2%, saddle PE); 30 day morbidity: Reexploration for bleeding-1(2.2%), pacemaker 3 (7%), no strokes. Mean follow-up of 22 months (range: 1–44 months). Clinical and echocardiographic review were done at six weeks, six-monthly for the first year and yearly thereafter. 38/45(85%) were in NYHA class 1. All on aspirin, none received anticoagulation, no incidence of ACH or I.E. One patient had right sided haemianopia (in AF preop). Valve function: Aortic regurgitation (AR) Valve sparing root: 22/24 (92%) had none to mild non progressive centralAR.Onepatient (bicuspid), developed severeAR three months post operative and required reoperation. Primary repair: 17/21 (81%) had trace to mild non progressive central AR.1/21 (tricuspid) has eccentric mild AR. 2/21(10%, 1-bicuspid, 1-tricuspid) has progressive central AR from none to mild at three year follow-up. 1/21 patient (bicuspid, type III restrictive) had no AR (severe preop) but has moderate aortic stenosis. Gradients: Valve sparing root; mean gradients: 2–8mm. Primary repair; mean gradients: 8–15mm. Type A Aortic dissection: 12/45 (27%).8/12 had severe preop AR. 5: valve sparing reimplantation and 7: (refashioning of STJ + cusp prolapse repair + subcommurissral annuloplasty). One mortality in redo aortic dissection. No reexploration for bleeding or stroke. All on aspirin, with trace to mild central non progressive AR in 10/11 (90%) patients at latest follow up. Conclusion:AVPP can be performed safely with acceptable outcomes. Long-term clinical and echocardiographic follow-up is essential. http://dx.doi.org/10.1016/j.hlc.2013.03.020 Monday 12 November – Session 2/1710 – 1720 Early Experience of Surgical TAVI – Approaches and Results Paul Wiemers ∗, May Tsai, Karl Poon, Darren Walters, Peter Tesar, Andrew Clarke The Prince Charles Hospital, Chermside, Australia Introduction: Transcatheter aortic valve implantation (TAVI) is nowawell recognisedprocedure for the high risk surgical patient with native or bioprosthetic aortic valve stenosis. Transfemoral and transapical implantation techniques are well described. We describe our early surgical TAVI experience including our adoption of a transaortic implantation technique due to its potential advantages. Methods: We retrospectively reviewed a systemised database and patient records for all patients undergoing surgical TAVI from the commencement date in our centre in 2/2010 to current. Results: A total of 45 patients with a mean age of 81.02± 5.65 yrs have undergone surgical TAVI in our centre. Twenty-nine of these procedures were performed transapically while the most recent 16 procedures were performed via a transaortic route. A significantly higher NYHAclassification (3.13 vs. 2.79; p= 0.036) and lower preprocedural LVEF (55.8 vs. 63.6%; p= 0.021) was observed in the transaortic group. The transapical group trended towards a higher predicted operative mortality (25.35 vs 18.59%; p= 0.082). Significant improvements were predictably observed in mean pressure gradients (MPG) across the aortic valve (47.8–13.0mmHg; p=