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Ann Thorac Surg. 2020 Feb;109(2):465-471. doi: 10.1016/j.athoracsur.2019.06.037. Epub 2019 Aug 7.

Impact of Aortic Atherosclerosis Burden on Outcomes of Surgical Aortic Valve Replacement.

Author information

1
Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
2
Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
3
Division of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, North Carolina.
4
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
5
Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Québec, Canada.
6
Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
7
Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: annetine.gelijns@mssm.edu.
8
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
9
Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
10
Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Washington, DC.
11
Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
12
Cardiovascular and Thoracic Surgery, Mission Health and Hospitals, Asheville, North Carolina.
13
Department of Cardiothoracic Surgery, The Heart Hospital Baylor Plano, Baylor Scott & White Health, Plano, Texas.
14
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Abstract

BACKGROUND:

Epiaortic ultrasound detects and localizes ascending aortic atherosclerosis. In this analysis we investigated the association between epiaortic ultrasound-based atheroma grade during surgical aortic valve replacement (SAVR) and perioperative adverse outcomes.

METHODS:

SAVR patients in a randomized trial of 2 embolic protection devices underwent a protocol-defined 5-view epiaortic ultrasound read at a core laboratory. Aortic atherosclerosis was quantified with the Katz atheroma grade, and patients were categorized as mild (grade I-II) or moderate/severe (grade III-V). Multivariable logistic regression was used to estimate associations between atheroma grade and adverse outcomes, including death, clinically apparent stroke, cerebral infarction on diffusion-weighted magnetic resonance imaging, delirium, and acute kidney injury (AKI) by 7 and 30 days.

RESULTS:

Precannulation epiaortic ultrasound data were available for 326 of 383 randomized patients (85.1%). Of these, 106 (32.5%) had moderate/severe Katz atheroma grade at any segment of the ascending aorta. Although differences in the composite of death, stroke, or cerebral infarction on diffusion-weighted magnetic resonance imaging by 7 days were not statistically significant, moderate/severe atheroma grade was associated with a greater risk of AKI by 7 days (adjusted odds ratio, 2.63; 95% confidence interval, 1.24-5.58; P = .01). At 30 days, patients with moderate/severe atheroma grade had a greater risk of death, stroke, or AKI (adjusted odds ratio, 1.97; 95% confidence interval, 1.04-3.71; P = .04).

CONCLUSIONS:

Moderate/severe aortic atherosclerosis was associated with an increased risk of adverse events after SAVR. Epiaortic ultrasound may serve as a useful adjunct for identifying patients who may benefit from strategies to reduce atheroembolic complications during SAVR.

PMID:
31400333
PMCID:
PMC6939455
[Available on 2020-08-06]
DOI:
10.1016/j.athoracsur.2019.06.037

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