Abstract 12550: Overexposed? Evaluating the Need for Serial Surveillance Imaging Following Elective Aortic Hemiarch Replacement

Abstract

Introduction: The optimal timing for imaging following ascending aortic replacement is unknown. Protocols currently differ based on institution. For the last 3 years, our institution has surveilled patients at 3 months, yearly for 3 years, and at 5 years following the operation. Hypothesis: We hypothesize surveillance CT scans performed at 3 months will identify any pathologies related to the ascending aortic repair that will require re-intervention; additional imaging may be superfluous. Methods: Using our single institution-maintained database, 311 patients who underwent an elective aortic hemiarch repair between February of 2010 and March of 2021 were identified. The timing for and stability of surveillance imaging was reviewed, paying special attention to pathology associated with the repair. Results: Of the 311 patients who underwent elective aortic hemiarch repair, 217 completed surveillance imaging. 187 patients had their initial imaging around 3 months following the operation, 85 patients completed imaging around one year, and 54 patients were imaged 2-8 years post-operatively with some patients undergoing multiple scans during this period. Nine patients required re-intervention; of these 9, four patients demonstrated pathology, on CT scan, associated with the actual ascending arch repair. Two patients developed a pseudoaneurysm (PSA), one at the distal aspect of the repair and one at the left ventricular outflow tract. The other two patients had degeneration of known distal aortic aneurysms. The two PSAs were intervened upon within the first 3 months and the degenerating aneurysms were intervened upon at 1 and 2.5 years post-operatively. Conclusions: These data support surveillance imaging completed at 3 months following ascending aortic replacement is sufficient to identify pathology related to the repair. While other indications may dictate ongoing surveillance, for most patients, the need for further imaging is potentially zero.