International Society For Minimally Invasive Cardiothoracic Surgery

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Comparison Of Outcomes Of The Florida Sleeve Procedure Between Bicuspid And Tricuspid Aortic Valve Patients
Seyed Hossein Aalaei Andabili1, Thomas M. Beaver1, Tomas Martin1, Philip Hess2, Eric Jeng1, George J. Arnaoutakis1.
1University of Florida, Gainesville, FL, USA, 2Indiana University, Indianapolis, IN, USA.

Introduction:Outcomes of the Florida Sleeve (FS) procedure in patients with bicuspid aortic valve (BAV) have not been reported before. We compared outcomes of the FS procedure in patients with BAV versus those with trileaflet aortic valve (TAV). Method: From May-2002-Jan-2018, 177 patients including 18 BAV and 159 TAV underwent the FS procedure. Baseline characteristics, perioperative outcomes, ventricular dimensions, ejection fraction, and degree of aortic insufficiency were compared between the two groups. Kaplan-Meier analysis evaluated survival and freedom from reintervention. Results: Mean±SD age and aortic root diameter were comparable in BAV and TAV groups, 47.83±11.19 versus 49.59±15.79 years (p=0.55) and 56.57±6.18 versus 55.17±8.84 millimeter (p=0.46), respectively. Thirteen (72.22%) patients in the BAV group and 115 (72.33%) patients in the TAV group were male (p=0.85).Left ventricular end systolic and diastolic diameters decreased from baseline to one-week in BAV group (p=0.037 and 0.12). Left ventricular end diastolic diameter improved at both one-week (p<0.001) and 30-day (p=0.001) in TAV group (Table-1). The 30-day mortality and stroke rates were zero in BAV group and 1.88% in TAV group (p=1.0). One patient (5.55%) in BAV group and 8 (5.03%) patients in TAV group needed permanent pacemaker implantation (p=0.62). Freedom from reoperation was 93% at 1 to 8-years in BAV group and 100% at 1 and 2-years and 99% at 3 to 8-years in TAV group (p=0.041). Patients' survival rate was 100% at 1 to 8-years in BAV group and 97% at 1-year, 96% at 2 to 5-years, and 91% at 6 to 8-years in AV group (p=0.42). Freedom from aortic insufficiency greater than mild was 93% in BAV group and 96.5% in TAV group at 5-years. Conclusion: This is the first report to examine outcomes of The Florida Sleeve procedure in patients with BAV. This technique is feasible and the results appear durable when compared to patients with TAV.

Table-1. Comparison of outcomes between bicuspid and tricuspid aortic valve patients after the Flori
VariablesBicuspid (n=18)Tricuspid (n=159)P-value
30-day mortality, N (%)0 (0%)3 (1.88%)1.0
Baseline left ventricular end-diastolic diameter, (mm),mean±SD49.25±2.2153.73±6.730.65
30-day left ventricular end-diastolic diameter, (mm),mean±SD46.50±5.4546.93±9.440.86
Baseline left ventricular end-systolic diameter (mm), mean±SD35.25±3.3036.89±8.210.85
30-day left ventricular end-systolic diameter (mm), mean±SD34.37±8.4834.82±9.070.91
Baseline ejection fraction, (%), mean±SD56.50±6.3057.13±6.520.83
30-day ejection fraction, (%), mean±SD53.50±11.3756.89±9.460.14
Baseline aortic insufficiency grade,mean±SD1.38±1.382.27±1.250.044
30-day aortic insufficiency grade,mean±SD0.2±0.421.24±0.880.001

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