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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • 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

Published Date

  • February 2020

Published In

Volume / Issue

  • 109 / 2

Start / End Page

  • 465 - 471

PubMed ID

  • 31400333

Pubmed Central ID

  • PMC6939455

Electronic International Standard Serial Number (EISSN)

  • 1552-6259

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2019.06.037


  • eng

Conference Location

  • Netherlands