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Randomized Controlled Trial
. 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

Alexander Iribarne  1 , Stephanie Pan  2 , Jock N McCullough  1 , Joseph P Mathew  3 , Judy Hung  4 , Xin Zeng  4 , Pierre Voisine  5 , Patrick T O'Gara  6 , Nancy M Sledz  2 , Annetine C Gelijns  7 , Wendy C Taddei-Peters  8 , Steven R Messé  9 , Alan J Moskowitz  2 , Vinod H Thourani  10 , Michael Argenziano  11 , Mark A Groh  12 , Gennaro Giustino  2 , Jessica R Overbey  2 , J Michael DiMaio  13 , Peter K Smith  14
Affiliations
Randomized Controlled Trial

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

Alexander Iribarne et al. Ann Thorac Surg. 2020 Feb.

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.

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Figures

Figure 1.
Figure 1.
Adjusted odds ratio for adverse events by 7 and 30 days after surgical aortic valve replacement.
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