Abstract 13370: Long-term Outcomes of Patients with Pseudoaneurysms and a History of Prior Cardiovascular Surgery

Abstract

Background: Data regarding long-term outcomes in patients with cardiovascular (CV) pseudoaneurysms (PSA) is sparse. In patients with prior CV surgery, we sought to assess outcomes in patients with PSAs (defined as paravalvular, aortic root, or ascending aorta PSAs) & compare them with matched controls. Methods: As part of a cohort study (total n=342), we included 114 patients with prior CV surgery who presented with paravalvular (n=71, 59 at the aortic valve & 12 at the mitral valve) & ascending aortic (n=43) PSAs. A control group of patients (n=228) with prior CV surgery, matched in a 2:1 fashion based on age, gender, type & time of CV surgery, were also included. Standard clinical, echocardiographic & surgical data was collected & Euroscore was calculated. A composite endpoint of death & stroke during follow-up were recorded. Results: Baseline data are shown in Figure A. 80% of patients in each group underwent redo CV surgery during follow-up. Over a follow-up of 6.7±4 years, there were 78 (23%) events (32 or 28% in PSA group & 46 or 20% in control group). 30-day events occurred in 7% of the PSA group & 1% of controls. Kaplan-Meier survival curves for the 2 groups are shown in Figure B. In the multivariate Cox Survival Analysis, Euroscore (HR 1.18 [1.10-1.27]) & the presence of PSA (HR 2.83 [1.66-4.85]) predicted a higher rate of events, while subsequent CV surgery (as a time-dependent covariate HR 0.38 [0.22-0.67])) & antibiotic use (HR 0.29 [0.27-0.31]) predicted improved freedom from events (all p<0.01). Conclusion: In patients with prior CV surgery, the presence of a cardiac PSA was associated with increased long-term adverse events, while redo CV surgery and antibiotic use improved outcomes.