Discussion

Presenter: Dr Markian Bojko Leonard N. Girardi (New York, NY). This report from the surgeons at University of Pennsylvania examines influence preoperative AI and root dimensions on development recurrent in patients who have undergone preservation surgery setting an acute type A dissection. Some 72% had “simple aortic valve resuspension” were stratified according to whether they less than 2 + or greater equal time index operation. Although degree was not predictive operative mortality, long-term survival, need for reoperation, authors demonstrated that with a sinus diameter 40 45 mm predicted mean 3 years Larger diameter, mm, did predict AI; interesting. The then opined their finding suggests tailored approach, increased postoperative echo surveillance may be warranted those receive dissection repair more operations. After reviewing data considering discussion results, I questions. used statistical method described by Clark quantify follow-up time, 477 hospital survivors reported as 4.8 years. Two figures your presentation show although 90% discharge echo, smaller percentage echoes 1, 3, 5, later well. Given importance real imaging rather substitute, how do we contextualize results you've presented here? (Philadelphia, Pa). It's excellent question. believe you're referring are bar graphs. To clear, numbers represented represent number unique echocardiographic studies particular interval. So, if example, frequency decreases every other year, let's say patient study during year 4 but come back 5 even 6, came 7, would included count 6 though he/she still remains up 7 actual is changing each graph that's these figures, makes it difficult appreciate follow-up. think better way understand many remained look risk table Kaplan–Meier curve. give representation actually on. Girardi. Patients also larger well ventricular diameters. You suggested down line, thus approach surveillance. However, operating room you somebody dilated root, large ventricle, should tailoring operation maybe bit aggressive surgery? Granted, conservative can produce consistent particularly experienced hands. hands institution like Penn, take dysfunction consider radical approach? Bojko. decision intervene made case-by-case basis keeping mind characteristics surgeon experience. limited clinical experience have, defer surgical decision-making algorithm one senior authors. Joseph E. Bavaria probably replace it. reason why we're sticking replacing now because there so them. Replacing SOV interesting all might regarding guidelines. If bicuspid dimensions, much? Bavaria. No, lot aggressive. In situation, unlike our work elective where work, usually proceed any When 45- 50-mm segment range, often found coming acuity, is, cardiogenic shock malperfusion. So 45-mm severe shock, inclination most get them out quickly safely possible, keep extensive What it's good gives outcomes, this demonstrates something about stratifying follow functional outcomes over long term. Unidentified Speaker. There's been regionalization complex surgery, obviously emergency category, Penn Healthcare System. Obviously, resources expertise tremendous. Have tried regionalize, otherwise stable, having malperfusion issues, necessarily same essence, right place options technical skills available operation? Prashanth Vallabhajosyula Haven, Conn). I'm sorry, me answer question Mark medical student. We call comes straight room, period. stratify make decisions there, best safest patient. started program, his has changed, culture maintained pulse when land helipad, bring everything save truly central reconstruction reperfusion through true lumen very important patients. addressing things, center, fortunately system happen. directly, UPenn Health Care open programs within system, only sites perform routinely. Of required mechanism identified besides AI? me, almost no trace AI, pretty much solved problem. really what happening recurrence. Any insights into that? Yes, just looked another trying happens Teflon felt patch reconstruction. Is durable routine cases intact? There will based gets received. But see dilatation rates segments faster several parameters independent immediate results. Other groups shown too. warrants As brought up, try hard regional referral following especially data, patients, speaks that.