Introduction The COVID-19 pandemic has severely impacted theatre utilization and patient care in cardiac surgery. This study assesses impact on theatre utilisation efficiency and cardiac care pathway during Covid compared to preCovid period. Method OR data for preCOVID period (1st Jan to 23rd Mar 2020) for major cardiac cases were compared to COVID period for predefined indices of OR utilisation and efficiency. Categorical variables were compared with Chi-squared and continuous variables with Man Whitney U test. P value<0.05 was considered significant. Results Total 363 surgeries were logged (304; preCovid, 59; COVID). There was significant reduction in cases/day (median 5 cases/day preCovid to 1 case/day during Covid, p<0.001). OR utilization capacity was less than 50% for 36/65 (55.4%) Covid days versus 5/59 (8.5%) preCovid days (p<0.001). Almost half the Covid days (43.1%) had no operations. Patients during Covid were younger (median 62 years vs 69 years, p<0.01) but higher risk (logEuroscore 6.6 vs 4.7, p<0.01). Index of operational efficiency (InOE) remained unchanged (preCovid;78.8% vs COVID;79%, p=0.90). Covid adversely affected Surgical efficiency (preCovid;74% vs COVID; 68.5%, p<0.001). Conclusion There was significantly decreased workflow due to reprioritization of resources. Operational service could be delivered to high efficiency despite significant changes in patient care pathways.

We describe conservative management of a rare type IIa endoleak after frozen elephant trunk operation with hybrid Thoraflex stent graft in chronic type B aortic dissection repair.

Background The aim of this study was to analyse the perioperative results and long term survival of re-sternotomy for surgical aortic valve replacement (SAVR) in octogenarians. Methods This is a retrospective, single centre study (Apr 2000 – Dec 2019). Perioperative data were compared for re-sternotomy with isolated SAVR (Isolated redoSAVR) and re-sternotomy with SAVR and concomitant cardiac procedure (Associated redoSAVR). Regression analyses were performed to identify predictors of in patient mortality. Hazard ratios were calculated, and Kaplan Meier survival curves were compared for groups. Results There were 163 patients (Isolated redoSAVR; 69, Associated redoSAVR; 94). Mean age was 83±3 years and mean logEuroSCORE was 21±12. Follow up was 4.2±3.5 years. Inpatient mortality was 4.9% (1.4% versus 7.4% for Isolated redoSAVR and Associated redoSAVR respectively, p=0.08). TIA/stroke rate was 8% (9% versus 7% for Isolated redoSAVR and Associated redoSAVR respectively, p=0.78). COPD was a predictor of inpatient mortality (OR; 8.86, 95%CI; 1.19, 66.11, p=0.03). Survival was 88.7% at 1 year, 86.4% at 2 years, 70.1% at 5 years, 49.5% at 7 years and 26.3% at 10 years. There was no survival difference between Isolated redoSAVR and Associated redoSAVR (logrank p=0.36, Wilcoxon p=0.84). Significant predictors of adverse long term survival were COPD, postoperative TIA/stroke and length of stay. Survival is lower than age and gender matched first time SAVR and general population of UK. Conclusions RedoSAVR in octogenarians is associated with acceptable but significant morbidity and mortality. Shared decision making should consider emerging transcatheter therapies as viable options in selected patients.

Objective - The aim was to evaluate early and long-term outcomes of re-sternotomy for aortic valve replacement with previous patent coronary artery grafts. Methods - Data for re-sternotomy for aortic valve replacements (group 1 isolated AVR, group 2 AVR with concomitant procedure) were collected (2000-19). Logistic regression analysis was performed to identify predictors of in-hospital mortality and postoperative composite outcome (in-hospital death, TIA/stroke, renal failure requiring new hemofiltration, deep sternal wound infection, re-exploration for bleeding/tamponade and length of stay >30 days). Survival curves were compared using log rank test. Cox proportion hazards model was used for predictors of long term survival. Results – Total 178 patients were included (groups 1 - 90 patients, group 2 - 88 patients). Mean age was 75±4 years and mean log EuroSCORE was 17±12% (15 ± 8% - group 1 vs 19 ± 14% - group 2, p=0.06). Mean follow up was 6.3±4.4 years. Cardiovascular injury occurred in 12%. LIMA was most commonly injured. In-hospital mortality was 7.8% (5% - group 1 versus 10.2% - group 2, p=0.247). NYHA class III-IV, perioperative IABP and cardiovascular injury were independent predictors of in-hospital mortality (HR; 13.33, 95% CI; 2.04, 83.33, p=0.007). Survival was significantly worse with cardio-vascular injury at re-sternotomy up to 5 years (46% versus 67%, p=0.025) and postoperative complications (p=0.023). Survival was significantly lower than age matched first time AVR and UK population. Conclusions – Long term survival is significantly impaired by cardiovascular injury and perioperative complications of re-sternotomy.

Background The Infection of aortic valve graft conduit is still burdened by notable morbidity and mortality. Medical and surgical strategies play a crucial role in patient outcome and vary depending on infection extend into adjacent cardiac structures, systemic spread and micro-organism involved. Methods In this retrospective study, we report our experience in the management of thirty consecutive patients admitted to our centre with composite aortic valve graft infection during the period 2008-2018. We review the early and mid-term outcomes of patients who underwent a reoperation or received a conservative medical treatment. Results Twenty patients underwent redo surgery with an early mortality of 10% and a survival of 83% at 7-year follow-up. Ten patients were treated medically and experienced an early mortality of 30% and a mid-term survival of 33%. Conclusion A surgical reoperation, despite a non-negligible perioperative risk, is the only radical treatment able to provide a good survival also in patients with complicated infective endocarditis.

Introduction - The impact of manufacturer labelled prosthesis size and predicted effective orifice area (EOA) on long term survival after aortic valve replacement is not clear although indexed effective orifice area (iEOA) has been associated with worse survival. Methods - Data was retrospectively collected from Jan 2000 – Dec 2019 for prosthesis type, model and size for isolated aortic valve replacements. Stratified survival was compared between groups and subgroups for labelled valve size, EOA and predicted PPM. Results – Total of 3444 patients were included. Moderate and severe PPM was 15.6% and 1.6% respectively. Cumulative life time hazard was worse for biological valves (mortality: biological 77.7% vs mechanical 64.8%, p=0.001). Mean survival was 132.7 months for biological versus 191.3 months for mechanical valves (p=0.001). Moderate prosthetic AS (EOA = 1-1.5 cm2) was12.1% and severe prosthetic AS (EOA≤1 cm2) was 0.8% respectively. Worse survival in the presence of moderate-severe prosthetic AS was seen in biological valves (115.2 months versus 133.7 months, p=0.001 for EOA≤1.5cm2 and >1.5cm2 respectively). There was a statistically significant correlation between survival and iEOA (Spearman’s rho=0.084, p=0.001, BCa bootstrap 95% CI;0.050, 0.120). Moderate to severe PPM (iEOA≤0.85cm2/m2) was a predictor of worse long term survival (HR 3.56; 95% CI: 1.37 - 9.25; p=0.009). Conclusion - Predicted prosthetic moderate to severe AS and moderate to severe PPM adversely affect long term survival. Smaller valves are associated with reduced survival in all groups.