320 slice ct angiography avoids the need for coronary angiography in selected cardiac surgical...

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S62 Heart, Lung and CirculationAbstracts 2009;18S:S1–S286

Cardiac Surgery

135REVIEW OF 18 YEARS EXPERIENCE WITH CRY-OPRESERVED AORTIC HOMOGRAFTS FOR THETREATMENT OF SEVERE AORTIC ROOT ENDO-CARDITIS

Emily Granger, Phillip Spratt, Paul Jansz, PeterMacdonald, Andrew Jackson, Helmi Albrecht, AlanFarnsworth

Department of Cardiothoracic Surgery, St Vincent’s HospitalSydney, Australia

Methods: All patients presenting to St Vincent’s Hos-pital with an aortic root infection requiring CAH over 18years were analysed. Data was collected retrospectivelyfrom medical charts and follow-up was via telephone and94% complete.

Results: From January 1991 to March 2009, 48 patients (36males, 12 females) with an average age 52.6 (from 26 to 86)underwent CAH replacement for aortic root infection. 33patients had endocarditis of a prosthetic valve and 15 hadnative valve endocarditis. 69% of patients required a redosternotomy. Microbiology of the infecting organism wasStaphylococcus aureus (24%), streptococcus species (28%)and no positive culture in 18%.

Homografts were inserted using the root replacementtechnique in 94% (45) cases and a subcoronary techniquein 6% (3) cases. Average cross-clamp time was 139 (45–273)minutes and average cardiopulmonary bypass time was194 (103–355) minutes. There were six patients peri-operative deaths (12.5%) due to massive haemorrhage andcardiac failure. Intra-operative death was associated withStaphylococcus aureus infection. Permanent post-operativepacemakers were required in 8 patients (17%).

Survival at 1 year and 10 years was 80% and 66% respec-tively. Freedom from re-operation was at 1 and 10 years76% and 67% respectively.

Discussion: Aortic root infections present a difficult sur-gical challenge in the setting of septic, haemodynamicallyunstable and coagulopathic patients. The aortic homograftprovides an excellent option for replacing the infectedaortic root as it is a compliant conduit with low risk ofreinfection, good haemodynamics and avoids the need forpost-operative Warfarin.

doi:10.1016/j.hlc.2009.05.137

136320 SLICE CT ANGIOGRAPHY AVOIDS THE NEEDFOR CORONARY ANGIOGRAPHY IN SELECTEDCARDIAC SURGICAL PATIENTS

A.D. Cochrane 1,2,3, A. Nasis 1, J.A. Smith 1,2,3, J.Cameron 1

1 Monash Cardiovascular Research Centre, MonashHeart,Southern Health and Department of Medicine (MMC), MonashUniversity, Melbourne, Australia2 Department of Cardiothoracic Surgery, Monash Medical Cen-tre, Clayton, Melbourne, Australia3 Department of Surgery (MMC), Monash University, Clayton,Melbourne, Australia

Background and purpose: 320 slice CT angiography(CTA) provides excellent definition of coronary anatomy,but coronary angiography remains the “gold standard”.In a number of groups of patients undergoing cardiacsurgery, angiography may have an increased risk, e.g.endocarditis, aortic dissection, while in other groups therate of coronary abnormalities may be low, e.g. in valvepatients without risk factors for angina, cardiac tumours.This study reviewed the ability of CTA to assess the coro-nary arteries, and avoid invasive angiography.

Methods: The initial 4 months of experience wasreviewed, and patients who satisfied the criteria were anal-ysed, to assess demographic factors, diagnosis, and theaccuracy of CTA.

Results: 14 patients underwent CTA as an alternative toinvasive coronary angiography. The mean age was 53 years(range 19–74), 10 were male. Diagnoses were—mitral valvesurgery (4 pts), cardiac tumour or mass (3), endocarditis(2 pts), aortic dissection (1), inability to engage RCA atangiography (1), aortic valve surgery (1), supravalvar aor-tic stenosis (1 pt) and right heart conduit replacement (1pt). Severe CAD was seen in 2 pts on CTA—one went ontoangiography which confirmed severe triple vessel disease,and the other went direct to valve surgery and a bypassgraft to the affected artery. There were no adverse eventsor complications.

Conclusion: 320 slice CT can reliably and safely replaceroutine coronary angiography in selected cases. Thisinvestigation is less invasive, more convenient for thepatient, quicker, cheaper, and therefore likely to be morecost-effective.

doi:10.1016/j.hlc.2009.05.138