2012 annual meeting & cardiothoracic forum - Society for ...

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ACTA-SCTS JOINT MEETING • Manchester Central Conference Centre 202 External Aortic Root Support Avoids Myocardial Ischaemia and Embolic Risk and Minimises Cardiopulmonary Bypass and Blood Product Requirements Authors: Tom Treasure 1 S. Crowe 1 B. Lees 2 K.M.J. Chan 2 A.M. Ranasinghe 3 R. Attia 4 T. Golesworthy 5 J. Pepper 2 1 Clinical Operational Research Unit UCL, United Kingdom; 2 Royal Brompton Hospital and Imperial College London, United Kingdom; 3 University of Birmingham, School of Clinical and Experimental Medicine and University Hospitals Birmingham, United Kingdom; 4 Guy’s and St Thomas’ Hospitals, United Kingdom; 5 Exstent Ltd, Tewkesbury, United Kingdom Objectives: A NICE technology appraisal considered external aortic root support (EARS) to be an alternative to aortic root replacement (ARR) in Marfan syndrome. To date all 30 patients who have had this surgery are alive and well following EARS surgery. This offers a reduction in the magnitude and risk of the surgical intervention, benefits we sought to quantify in a comparative evaluation. Methods: From May 2004 to December 2009 a pliant, custom-made support, engineered with computer aided design was implanted in the first 20 patients. Patients having ARR for Marfan syndrome, in the same time frame, in two other cardiac surgical units, were identified. Without reference to any procedural or outcome data, a group matched by minimisation for age, aortic size and valve function was identified from amongst these patients. Data were then retrieved for bypass and ischaemic time, blood loss, and transfusion of blood products. Results: The degree of matching of ARR and EARS patients is shown in the table. Of 20 ARR patients 16 had valve-sparing surgery and 4 had composite grafts. The operation, bypass and ischaemic times were as shown. Only the first EARS patient had a precautionary 20 minutes of bypass. A difference in blood loss commensurate with shorter operating times and the avoidanced of bypass is recorded. One EARS patient received blood transfusion. Data on blood product usage in 18/20 ARR patients is shown. Aortic Root External aortic Replacement root support Age in years: median (IQR) 35 (27-43) 33 (26-39) Aortic root diameter mm: median (IQR) 48.5 (44-52) 47 (43-48) Operation time mins: median (IQR) 240 (204-269) 148 (136-163) Bypass time mins: median (IQR) 134 (117-146) 0 (0-0) Cross clamp time mins: (median IQR) 114 (91-127) 0 (0-0) Blood lost mls in 1st 4 hours: 230 (155-370) 50 (50-100) (median IQR) Red cell transfusion: (patients) 9/18 1/20 Platelet transfusion: (patients) 9/18 0/20 Fresh frozen plasma: (patients) 12/18 0/20 264
JOINT ANNUAL MEETING 2012 ABSTRACTS Conclusions: As surgery is offered earlier in the course of aortic dilatation, the statistic “number needed to treat” to prevent a dissection increases. An essential component in evaluation is quantification of the harm and cost for each intervention as NNtT increases. This study offers comparable data including variability for EARS and ARR appropriate for decision making and health economic evaluation. Hypothesis testing statistical tests were not appropriate because the differences in operating procedures were by intent rather than a research finding. 265
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