Impact of Aortic Atherosclerosis Burden on Outcomes of Surgical Aortic Valve Replacement
| Autor: | Peter K. Smith, Judy Hung, Michael Argenziano, Alan J. Moskowitz, Stephanie Pan, Wendy C. Taddei-Peters, Jessica Overbey, Pierre Voisine, Vinod H. Thourani, Mark A. Groh, Jock N. McCullough, Patrick T. O'Gara, Alexander Iribarne, J. Michael DiMaio, Gennaro Giustino, Xin Zeng, Steven R. Messé, Annetine C. Gelijns, Nancy M. Sledz, Joseph P. Mathew |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Aortic Diseases Heart Valve Diseases 030204 cardiovascular system & hematology Severity of Illness Index 03 medical and health sciences Postoperative Complications 0302 clinical medicine Aortic valve replacement Internal medicine medicine.artery Ascending aorta medicine Humans Stroke Aorta Aged Aged 80 and over Heart Valve Prosthesis Implantation Aortic atherosclerosis Cerebral infarction business.industry Odds ratio Perioperative Atherosclerosis medicine.disease 3. Good health Treatment Outcome Atheroma 030228 respiratory system Aortic Valve cardiovascular system Cardiology Female Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 109:465-471 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2019.06.037 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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