Abstract 15814: Postoperative Surveillance Imaging Following Elective Aortic Hemiarch Replacement

Abstract

Introduction: The optimal protocol for imaging following aortic hemiarch replacement remains a topic of debate with varied intervals at each institution. For the last 3 years, our institution has surveilled patients at 3 months, yearly for 3 years, and at 5 years. 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, 348 patients who underwent an elective aortic hemiarch repair between February of 2010 and December of 2021 were identified. One patient with a restricted chart was excluded. The timing for and stability of surveillance imaging was reviewed, paying special attention to pathology associated with the repair. Results: Of the 347 patients, 274 completed surveillance imaging. 231 patients had their initial imaging around 3 months following the operation, 126 patients completed imaging around one year, and 72 patients were imaged 2-10 years post-operatively with some patients undergoing multiple scans during this period. Ten patients required re-intervention; of these 10, two patients demonstrated pathology, on CT scan, associated with the actual ascending aortic repair. These two patients developed a pseudoaneurysm (PSA), one at the distal aspect of the repair and one at the left ventricular outflow tract. Another 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 hemiarch 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.