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138 Can patient safety and outcomes be preserved during learning curve for an innovative surgical procedure? the early results of wolverhampton aortic valve repair programme
  1. Maciej Matuszewski,
  2. Patrick Yiu,
  3. Antonella Meraglia,
  4. Giuseppe Bozzetti,
  5. Farhanda Ahmad
  1. New Cross Hospital

Abstract

Aim to evaluate early clinical and echocardiography outcomes of our recently initiated aortic valve repair (AV repair) programme.

Methods 26 patients were accepted for AV repair/replacement, starting in April 2014. The preoperative imaging was reviewed by our Cardiac MDT and by our proctor, Dr Emmanuel Lansac. The indications for surgery are listed in table 1.

Abstract 138 Table 1

There were 17 men and 9 women, with median age 58.5 years (22–76 years). The proctor assisted in 9 cases; otherwise all procedures were performed by both first authors operating together. Follow up was 100% complete.

Results In 5 cases, AV repair was not deemed feasible intraoperatively, and was not attempted. AV repair was attempted in 21 and successfully completed in 19 patients (Repair Group; Table 2), including 6 bicuspid and 13 tricuspid aortic valves. The remaining 7 patients underwent AVR ± root replacement (Replacement Group).

Abstract 138 Table 2

There were no deaths and no strokes. 1 patient in Repair Group developed atrial flutter, treated successfully by catheter ablation. 1 patient with isolated bicuspid valve repair has recurrent asymptomatic grade 3 AR seven months postoperatively. 1 patient in Replacement Group (background of SLE) was diagnosed with mechanical prosthesis dysfunction, and underwent bioprosthetic redo AVR. The valve leaflet was blocked by pannus. Another patient from Replacement Group, who had poor LV preoperatively, underwent CRT implantation. 1 patient from Repair Group (5%) and 3 from Replacement Group (43%) group are in group NYHA 2; the others are asymptomatic and well. 7 patients in Repair Group (37%) and 1 in Replacement Group (14%) are not on any antiplatelet or anticoagulant medications. The median follow up in Repair Group was 16 months. The median AR grade was reduced from 3 to 1 (p<0.01 in Wilcoxon matched-pair singed-rank test). The freedom from AR grade 2 or more was 79%, and freedom from AR grade 3 or more 95%. In patients in whom the proctor directly assisted, the freedom from AR grade 2 or more was 100%. The difference in AR reduction between proctored and independent procedures was not statistically significant (p=0.084 in independent-samples Mann-Whitney U test).

Conclusion These results reflect our learning curve. We feel we have achieved acceptable early results independently after the initial, directly assisted, procedures. We still need further experience, and an on-going dialogue with the proctor about the decision-making in AV repair will assist our progress.

  • aortic valve repair
  • aorta
  • learning curve

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