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

Publication ,  Journal Article
Iribarne, A; Pan, S; McCullough, JN; Mathew, JP; Hung, J; Zeng, X; Voisine, P; O'Gara, PT; Sledz, NM; Gelijns, AC; Taddei-Peters, WC; Groh, MA ...
Published in: Ann Thorac Surg
February 2020

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.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

February 2020

Volume

109

Issue

2

Start / End Page

465 / 471

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Respiratory System
  • Postoperative Complications
  • Male
  • Humans
  • Heart Valve Prosthesis Implantation
  • Heart Valve Diseases
  • Female
  • Atherosclerosis
 

Citation

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Iribarne, A., Pan, S., McCullough, J. N., Mathew, J. P., Hung, J., Zeng, X., … Smith, P. K. (2020). Impact of Aortic Atherosclerosis Burden on Outcomes of Surgical Aortic Valve Replacement. Ann Thorac Surg, 109(2), 465–471. https://doi.org/10.1016/j.athoracsur.2019.06.037
Iribarne, Alexander, Stephanie Pan, Jock N. McCullough, Joseph P. Mathew, Judy Hung, Xin Zeng, Pierre Voisine, et al. “Impact of Aortic Atherosclerosis Burden on Outcomes of Surgical Aortic Valve Replacement.Ann Thorac Surg 109, no. 2 (February 2020): 465–71. https://doi.org/10.1016/j.athoracsur.2019.06.037.
Iribarne A, Pan S, McCullough JN, Mathew JP, Hung J, Zeng X, et al. Impact of Aortic Atherosclerosis Burden on Outcomes of Surgical Aortic Valve Replacement. Ann Thorac Surg. 2020 Feb;109(2):465–71.
Iribarne, Alexander, et al. “Impact of Aortic Atherosclerosis Burden on Outcomes of Surgical Aortic Valve Replacement.Ann Thorac Surg, vol. 109, no. 2, Feb. 2020, pp. 465–71. Pubmed, doi:10.1016/j.athoracsur.2019.06.037.
Iribarne A, Pan S, McCullough JN, Mathew JP, Hung J, Zeng X, Voisine P, O’Gara PT, Sledz NM, Gelijns AC, Taddei-Peters WC, Messé SR, Moskowitz AJ, Thourani VH, Argenziano M, Groh MA, Giustino G, Overbey JR, DiMaio JM, Smith PK. Impact of Aortic Atherosclerosis Burden on Outcomes of Surgical Aortic Valve Replacement. Ann Thorac Surg. 2020 Feb;109(2):465–471.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

February 2020

Volume

109

Issue

2

Start / End Page

465 / 471

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Respiratory System
  • Postoperative Complications
  • Male
  • Humans
  • Heart Valve Prosthesis Implantation
  • Heart Valve Diseases
  • Female
  • Atherosclerosis