Abstract 4147337: The Aortic Inflammation Affects Long-Term Freedom From Reintervention After Bentall Procedure

Background: The impact of aortic inflammation on aortic surgery is still unclear. Hypothesis: The aortic inflammation affects the freedom from reintervention in the distal native aorta following the Bentall procedure. Methods: This is a retrospective observational study performed on the aortic histology of patients over 18 years old who underwent a Bentall procedure in a single centre, from 2000 to 2023. Variables included demographics, cardiovascular risk factors and ascending aorta diameter. The follow-up verified death or reintervention on the distal aorta. The relationship between the aortic inflammation and cardiovascular risk factors was tested with Logistic Regression, expressed as odds ratio (OR) and 95% confidence interval (CI95%). The Cox regression evaluated if inflammation was a significant predictor for survival and reintervention, expressed as hazard ratio (HR) and 95%CI. The Kaplan-Meier curves for the freedom from reintervention stratified by inflammation were compared with the Tarone-Ware test. Results: Data concerning 1327 patients was gathered: 61(4.6%) had aortic inflammation. The median follow-up was 4.3 years (Interquartile 1.5-8.1 years). The inflammation was associated with females (OR3.5 CI95% 1.9-6.2 p<0.01), age (OR1.1 CI95% 1.01-1.08 p=0.01), and increased ascending aorta diameter (OR1.1 CI95% 1.05-1.1 p<0.01), but not with aortic dissection (OR0.5 CI95% 0.2-1.1 p=0.08). Inflamed aorta did not increase mortality (HR1.4 CI95% 0.8-2.6 p=0.23). However, inflammation was the strongest risk factor for reintervention on the distal aorta (HR6.8 CI95% 3.1-15.2 p<0.01), independently from aortic dissection (HR3.2 CI95% 1.5-6.6 p<0.01), elevated ascending aorta diameter (HR1.1 CI95% 1.01-1.05 p=0.05), body max index (HR0.9 CI95% 0,84-0,97 p<0.01). The Kaplan-Meier curves confirmed that an inflamed aorta provided lower freedom from reintervention than one without inflammation (Figure 1, Tarone-Ware Test p<0.01). Conclusions: Aortic inflammation in patients treated with the Bentall procedure is associated with age, female, and increased ascending aorta diameter. Inflammation doesn’t affect survival after surgery. However, it strongly increases the risk of reintervention in the distal native aorta.