P029 - SURGICAL MANAGEMENT OF GIANT CELL AORTITIS OF THE THORACIC AORTA : PERIOPERATIVE OUTCOMES AND IMPORTANCE OF LATE FOLLOW-UP IN 89 CONSECUTIVE PATIENTS

Background: With the aging population, giant cell aortitis (GCA) is recognized more frequently. While all aortic segments may be involved, few reports assess the specific presentation and the operative results of GCA of the thoracic aorta. Furthermore, data on late outcome is sparse.

METHODS AND RESULTS: Through our prospectively collected databank, we identified all consecutive patients who underwent surgery on the thoracic aorta and had a histologic diagnosis of GCA. Patients were followed in a dedicated aortic clinic, and late outcomes were assessed. Among 89 patients with a GCA diagnosis, 57 (64.0%) were female, 95.5% presented electively and 4.5% with acute dissection. Ten (12.2%) patients were on preoperative immunosuppressive therapy. The ascending aorta was involved in all patients. Arch replacement was required in 74 (83.1%) patients (82.4% hemiarch, 17.6% total arch ± frozen elephant trunk). Root surgery was performed in 36 (40.4%) patients, while concomitant CABG in 12 (13.5%) and mitral ± tricuspid valve repair/replacement in 16 (18.0%). Cross-clamp and cardiopulmonary bypass times were 68.4 ± 34.2 minutes and 103.4 ± 43.8 minutes, respectively. No hospital mortality occurred. One (1.1%) patient suffered a stroke, 6 (6.7%) required reoperation for bleeding, and the mean hospital stay was 9.4 ± 6.0 days. Forty-eight (59.3%) patients received postoperative immunosuppressive therapy based on elevated serum inflammatory markers or residual aortic inflammation on PET scan. At a mean follow-up of 7.3 ± 4.9 years, 19 (21.3%) patients had died (5 and 10-year survival: 92.1% and 77.8%, respectively), with 5 deaths due to aortic rupture (5 and 10-year freedom from aortic-related death: 95.0% and 88.9%). At follow-up, 2 (2.2%) patients required thoracoabdominal aortic replacement and 2 required distal stent-graft extension (5 and 10-year freedom from aortic reintervention: 94.4% and 91.8%). Additionally, 3 (3.3%) patients underwent valvular reoperations, including one case of Bentall endocarditis.

Conclusion: Although the ascending aorta is involved in all GCA cases, extended disease may require complex arch procedures. Excellent perioperative results may be expected in this none atherosclerotic population. Late disease progression mandates lifelong imaging and medical follow-up. Optimal immunosuppressive management remains to be defined.