1
|
Knol WG, Budde RPJ, Mahtab EAF, Bekkers JA, Bogers AJJC. Intimal aortic atherosclerosis in cardiac surgery: surgical strategies to prevent embolic stroke. Eur J Cardiothorac Surg 2021; 60:1259-1267. [PMID: 34329374 PMCID: PMC8643442 DOI: 10.1093/ejcts/ezab344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Although the incidence of perioperative stroke after cardiac surgery gradually decreased over the last decades, there is much variation between centres. This review aimed to create a concise overview of the evidence on possible surgical strategies to prevent embolic stroke in patients with intimal aortic atherosclerosis. METHODS The PubMed and EMBASE databases were searched for studies on surgical management of aortic atherosclerosis and the association with perioperative stroke in cardiac surgery, including specific searches on the most common types of surgery. Articles were screened with emphasis on studies comparing multiple strategies and studies reporting on the patients’ severity of aortic atherosclerosis. The main findings were summarized in a figure, with a grade of the corresponding level of evidence. RESULTS Regarding embolic stroke risk, aortic atherosclerosis of the tunica intima is most relevant. Although several strategies in general cardiac surgery seem to be beneficial in severe disease, none have conclusively been proven most effective. Off-pump surgery in coronary artery bypass grafting should be preferred with severe atherosclerosis, if the required expertise is present. Although transcatheter aortic valve replacement is used as an alternative to surgery in patients with a porcelain aorta, the risk profile concerning intimal atherosclerosis remains poorly defined. CONCLUSIONS A tailored approach that uses the discussed alternative strategies in carefully selected patients is best suited to reduce the risk of perioperative stroke without compromising other outcomes. More research is needed, especially on the perioperative stroke risk in patients with moderate aortic atherosclerosis.
Collapse
Affiliation(s)
- Wiebe G Knol
- Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands.,Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ricardo P J Budde
- Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Edris A F Mahtab
- Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Jos A Bekkers
- Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| |
Collapse
|
2
|
Charbonnel C, Jego C, Jourda F, Vinsonneau U, Garçon P, Turlotte G, Rivière JF, Maurin M, Lubret R, Meimoun P, Akret C, Cournot M, Sokic C, Michel L, Lescure M, Kenizou D, Melay M, Fayard M, Gallet B, Fouche R, Janin-Manificat L, Dijoux N, Martin AC, Tho-Agostini A, Mann H, Ricard C, Pico F, Georges JL, Belle L, Jourdain P. ADAM-C score: New risk score for predicting diagnostic yield of transesophageal echocardiography after cerebral ischemia. Echocardiography 2018; 35:1171-1182. [PMID: 29756387 DOI: 10.1111/echo.14010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIM The clinical utility of transesophageal echocardiography (TEE) after brain ischemia (BI) remains a matter of debate. We aimed to evaluate the clinical impact of TEE and to build a score that could help physicians to identify which patients should better benefit from TEE. METHODS This prospective, multicenter, observational study included patients over 18 years old, hospitalized for BI. TEE findings were judged discriminant if the results showed important information leading to major changes in the management of patients. Most patients with patent foramen ovale were excluded. Variables independently associated with a discriminant TEE were used to build the prediction model. RESULTS Of the entire population (1479 patients), 255 patients (17%) were classified in the discriminant TEE group. Five parameters were selected as predictors of a discriminant TEE. Accordingly, the ADAM-C score could be calculated as follows: Score = 4 (if age ≥60) + 2 (if diabetes) + 2 (if aortic stenosis from any degrees) + 1 (if multi-territory stroke) + 2 (if history of coronary artery disease). At a threshold lower than 3, the sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of detecting discriminant TEE were 88% (95% CI 85-90), 44% (95% CI 41-47), 21% (95% CI 19-27), and 95% (95% CI 94-97), respectively. CONCLUSION A simple score based on clinical and transthoracic echocardiographic parameters can help physicians to identify patients who might not benefit from TEE. Indeed, a score lower than 3 has an interesting NPV of 95% (95% CI 94-97).
Collapse
Affiliation(s)
| | - Christophe Jego
- Department of Cardiology, Toulon Inter-army Hospital, Toulon, France
| | | | - Ulric Vinsonneau
- Department of Cardiology, Brest Inter-army Hospital, Brest, France
| | - Philippe Garçon
- Department of Cardiology, Saint Joseph Hospital, Paris, France
| | - Guillaume Turlotte
- Department of Cardiology, La Roche sur Yon Hospital, La Roche sur Yon, France
| | | | - Marion Maurin
- Department of Cardiology, Papeete Hospital, Papeete, France
| | - Rémy Lubret
- Department of Cardiology, Boulogne sur mer Hospital, Boulogne sur mer, France
| | - Patrick Meimoun
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Chrystelle Akret
- Department of Cardiology, Annecy-Genevois Hospital, Annecy, France
| | - Maxime Cournot
- Department of Cardiology, Saint Paul Hospital, Saint Paul, France
| | - Charles Sokic
- Department of Cardiology, Haguenau Hospital, Haguenau, France
| | - Laurent Michel
- Department of Cardiology, Saint Lo Hospital, Saint Lo, France
| | | | - David Kenizou
- Department of Cardiology, Mulhouse Hospital, Mulhouse, France
| | - Marie Melay
- Department of Cardiology, Vichy Hospital, Vichy, France
| | - Maxime Fayard
- Department of Cardiology, Chalon sur Saone Hospital, Chalon sur Saone, France
| | - Bruno Gallet
- Department of Cardiology, Argenteuil Hospital, Argenteuil, France
| | - Rémi Fouche
- Department of Cardiology, Montbéliard Hospital, Montbéliard, France
| | | | - Nicolas Dijoux
- Department of Cardiology, Saint Pierre Hospital, Saint Pierre, France
| | - Anne Céline Martin
- Department of Cardiology, Val de Grace Inter-army Hospital, Paris, France
| | | | - Hubert Mann
- Department of Cardiology, Voiron Hospital, Voiron, France
| | - Cécile Ricard
- Department of Cardiology, Annecy-Genevois Hospital, Annecy, France
| | - Fernando Pico
- Department of Neurology, Versailles Hospital, Le Chesnay, France.,University of Versailles, Saint-Quentin en Yvelines and Paris Saclay, Saint-Quentin en Yvelines, France
| | | | - Loïc Belle
- Department of Cardiology, Annecy-Genevois Hospital, Annecy, France
| | | | | |
Collapse
|
3
|
Nishimura S, Izumi C, Imanaka M, Kuroda M, Takahashi Y, Yoshikawa Y, Amano M, Onishi N, Sakamoto J, Tamaki Y, Enomoto S, Miyake M, Tamura T, Kondo H, Kaitani K, Nakagawa Y. Impact of aortic plaque on progression rate and prognosis of aortic stenosis. Int J Cardiol 2018; 252:144-149. [PMID: 29249424 DOI: 10.1016/j.ijcard.2017.09.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUNDS Patients with aortic stenosis (AS) have a high prevalence of aortic plaque. However, no data exist regarding the clinical significance and prognostic value of aortic plaque in AS patients. This study examines the impact of aortic plaque on the rate of progression and clinical outcomes of AS. METHODS We retrospectively investigated 1812 transesophageal echocardiographic examinations between 2008 and 2015. We selected 100 consecutive patients (mean age; 75.1±7.4years) who showed maximal aortic jet velocity (AV-Vel) ≥2.0m/s by transthoracic echocardiography (TTE) and received follow-up TTE (mean follow-up duration 25±17months), and the mean progression rate of AV-Vel was calculated. Clinical and echocardiographic characteristics, including severity of aortic plaque, and cardiac events were examined. RESULTS At initial TTE, mean AV-Vel was 3.68±0.94m/s and mean aortic valve area 0.98±0.32cm2. Mean progression rate of AV-Vel was 0.41m/s/year in 38 patients with severe aortic plaque, and -0.03m/s/year in the remaining 62 patients without severe aortic plaque. Severe aortic plaque (odds ratio[OR], 8.32) and hemodialysis (OR, 6.03) were independent predictors of rapid progression. The event-free survival rate at 3years was significantly lower in patients with severe aortic plaque than in those without (52% vs 82%, p=0.002). Severe aortic plaque (hazard ratio[HR], 2.89) and AV-Vel at initial TTE (HR, 3.28) were identified as independent predictors of cardiac events. CONCLUSION Severe aortic plaque was a predictor of rapid progression and poor prognosis in AS patients. Evaluation of aortic plaque provides additional information regarding surgical scheduling and follow-up.
Collapse
Affiliation(s)
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan.
| | - Miyako Imanaka
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Maiko Kuroda
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | | | | | - Masashi Amano
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Naoaki Onishi
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Jiro Sakamoto
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Yodo Tamaki
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | | | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | | | - Hirokazu Kondo
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Kazuaki Kaitani
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | | |
Collapse
|
4
|
Aorta calcification burden: Towards an integrative predictor of cardiac outcome after transcatheter aortic valve implantation. Atherosclerosis 2016; 246:161-8. [DOI: 10.1016/j.atherosclerosis.2016.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 12/24/2015] [Accepted: 01/08/2016] [Indexed: 11/18/2022]
|
5
|
Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: A two-center study. Atherosclerosis 2015; 243:631-7. [DOI: 10.1016/j.atherosclerosis.2015.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/20/2015] [Accepted: 10/07/2015] [Indexed: 01/07/2023]
|
6
|
Aortic arch atherosclerosis in patients with severe aortic stenosis can be argued by greater day-by-day blood pressure variability. Atherosclerosis 2015; 241:42-7. [DOI: 10.1016/j.atherosclerosis.2015.04.807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/28/2015] [Accepted: 04/29/2015] [Indexed: 11/23/2022]
|
7
|
Fujita S, Sugioka K, Matsumura Y, Ito A, Hozumi T, Hasegawa T, Hanatani A, Naruko T, Ueda M, Yoshiyama M. Impact of concomitant coronary artery disease on atherosclerotic plaques in the aortic arch in patients with severe aortic stenosis. Clin Cardiol 2013; 36:352-7. [PMID: 23585299 DOI: 10.1002/clc.22121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 03/03/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) often occurs concurrently in patients with severe aortic stenosis (AS). However, the influence of concomitant CAD on the presence of atherosclerotic complex plaques in the aortic arch, which is associated with increased stroke risk, has not been fully assessed in patients with severe AS. HYPOTHESIS We hypothesized that concomitant CAD would be associated with the presence of complex arch plaques in patients with severe AS. METHODS The study population consisted of 154 patients with severe AS who had undergone transesophageal echocardiography (TEE) and coronary angiography (71 male; mean age, 72 ± 8 years; mean aortic valve area, 0.67 ± 0.15 cm(2) ). Aortic arch plaques were assessed using TEE, and complex arch plaques were defined as large plaques (≥4 mm), ulcerated plaques, or mobile plaques. RESULTS The prevalence of aortic arch plaques (87% vs 70%; P = 0.03) and complex arch plaques (48% vs 20%; P < 0.001) was significantly greater in AS patients with CAD than in those without CAD. After adjustment for traditional atherosclerotic risk factors, we found that concomitant CAD was independently associated with the presence of complex arch plaques (odds ratio: 2.86, 95% confidence interval: 1.23-6.68, P = 0.01). CONCLUSIONS In patients with severe AS, concomitant CAD is associated with severe atherosclerotic burden in the aortic arch. This observation suggests that AS patients with concomitant CAD are at a higher risk for stroke, and that careful evaluation of complex arch plaques by TEE is needed for the risk stratification of stroke in these patients.
Collapse
Affiliation(s)
- Suwako Fujita
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Bobrowska B, Zasada W, Surdacki A, Rakowski T, Kleczyński P, Świerszcz J, Kruszelnicka O, Rajtar-Salwa R, Arif S, Sorysz D, Dudek D, Dubiel JS. Predictors of coronary and carotid atherosclerosis in patients with severe degenerative aortic stenosis. Int J Med Sci 2013; 10:1361-6. [PMID: 23983597 PMCID: PMC3752723 DOI: 10.7150/ijms.6389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/21/2013] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Patients with degenerative aortic stenosis (AS) exhibit elevated prevalence of coronary artery disease (CAD) and internal carotid artery stenosis (ICAS). Our aim was to investigate prevalence of significant CAD and ICAS in relation to demographic and cardiovascular risk profile among patients with severe degenerative AS. METHODS We studied 145 consecutive patients (77 men and 68 women) aged 49-91 years (median, 76) with severe degenerative AS who underwent coronary angiography and carotid ultrasonography in our tertiary care center. The patients were divided into two groups according to the presence of either significant CAD (n=86) or ICAS (n=22). RESULTS The prevalence of significant CAD or ICAS was higher with increasing number of traditional risk factors (hypertension, hypercholesterolemia, diabetes, smoking habit) and decreasing renal function. We found interactions between age and gender in terms of CAD (p=0.01) and ICAS (p=0.06), which was confirmed by multivariate approach. With the reference to men with a below-median age, the prevalence of CAD or ICAS increased in men aged >76 years (89% vs. 55% and 28% vs. 14%, respectively), whereas the respective percentages were lower in older vs. younger women (48% vs. 54% and 7% vs. 17%). CONCLUSIONS In severe degenerative AS gender modulates the association of age with coronary and carotid atherosclerosis with its lower prevalence in women aged >76 years compared to their younger counterparts. This may result from a hypothetical "survival bias", i.e., an excessive risk of death in very elderly women with severe AS and coexisting relevant coronary or carotid atherosclerosis.
Collapse
Affiliation(s)
- Beata Bobrowska
- 2nd Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College and University Hospital, Cracow, Poland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Sugioka K, Matsumura Y, Hozumi T, Fujita S, Ito A, Kataoka T, Takagi M, Mizutani K, Naruko T, Hosono M, Hirai H, Sasaki Y, Ueda M, Suehiro S, Yoshiyama M. Relation of aortic arch complex plaques to risk of cerebral infarction in patients with aortic stenosis. Am J Cardiol 2011; 108:1002-7. [PMID: 21798492 DOI: 10.1016/j.amjcard.2011.05.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/12/2011] [Accepted: 05/12/2011] [Indexed: 11/17/2022]
Abstract
Aortic stenosis (AS) and systemic atherosclerosis have been shown to be closely related. We evaluated the prevalence of aortic arch plaques and their possible association with the risk of cerebral infarction in patients with severe AS. Transesophageal echocardiography was performed in 116 patients with severe AS (55 men, mean age 71 ± 7 years, mean aortic valve area 0.68 ± 0.15 cm(2)) who were scheduled for aortic valve replacement. The presence, thickness, and morphology of the aortic arch plaques were evaluated using transesophageal echocardiography. Cerebral infarcts (chronic cerebral infarction and cerebral infarction after cardiac catheterization and aortic valve replacement) were assessed in all patients. Compared to age- and gender-matched control subjects, the patients with severe AS had a significantly greater prevalence of aortic arch plaques (74% vs 41%; p <0.0001) and complex arch plaques such as large plaques (≥4 mm), ulcerated plaques, or mobile plaques (30% vs 10%; p = 0.004). Multivariate logistic analyses showed that the presence of complex arch plaques was independently associated with cerebral infarction in patients with AS after adjusting for traditional atherosclerotic risk factors and coronary artery disease (odds ratio 8.46, 95% confidence interval 2.38 to 30.12; p = 0.001). In conclusion, the results from the present study showed that there is a greater prevalence of aortic arch plaques in patients with AS and that the presence of complex plaques is independently associated with cerebral infarction in these patients. Therefore, the identification of complex arch plaques using transesophageal echocardiography is important for risk stratification of cerebrovascular events in patients with severe AS.
Collapse
Affiliation(s)
- Kenichi Sugioka
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Michelena HI, Abel MD, Suri RM, Freeman WK, Click RL, Sundt TM, Schaff HV, Enriquez-Sarano M. Intraoperative echocardiography in valvular heart disease: an evidence-based appraisal. Mayo Clin Proc 2010; 85:646-55. [PMID: 20592170 PMCID: PMC2894720 DOI: 10.4065/mcp.2009.0629] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Intraoperative (IO) transesophageal echocardiography (TEE) is widely used for assessing the results of valvular heart disease (VHD) surgery. Epiaortic ultrasonography (EAU) has been recommended for prevention of perioperative strokes. To what extent does high-quality evidence justify the widespread use of these imaging modalities? In March 2009, we searched MEDLINE (PubMed and OVID interfaces) and EMBASE for studies published in English using database-specific controlled vocabulary describing the concepts of IOTEE, cardiac surgery, VHD, and EAU. We found no randomized trials or studies with control groups assessing the impact of IOTEE in VHD surgery. Pooled analysis of 8 observational studies including 15,540 patients showed an average incidence of 11% for prebypass surgical changes and 4% for second pump runs, suggesting that patients undergoing VHD surgery may benefit significantly from IOTEE, particularly from postcardiopulmonary bypass IOTEE in aortic repair and mitral repair and replacement, but less so in isolated aortic replacement. Further available indirect evidence was satisfactory in the test accuracy and surgical quality control aspects, with low complication rates for IOTEE. The data supporting EAU included 12,687 patients in 2 prospective randomized studies and 4 nonrandomized, controlled studies, producing inconsistent outcome-related results. Despite low-quality scientific evidence supporting IOTEE in VHD surgery, we conclude that indirect evidence supporting its use is satisfactory and suggests that IOTEE may offer considerable benefit in valvular repairs and mitral replacements. The value of IOTEE in isolated aortic valve replacement remains less clear. Evidence supporting EAU is scientifically more robust but conflicting. These findings have important clinical policy and research implications.
Collapse
Affiliation(s)
- Hector I Michelena
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Zingone B, Gatti G, Spina A, Rauber E, Dreas L, Forti G, Pappalardo A. Current role and outcomes of ascending aortic replacement for severe nonaneurysmal aortic atherosclerosis. Ann Thorac Surg 2010; 89:429-34. [PMID: 20103316 DOI: 10.1016/j.athoracsur.2009.11.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 11/11/2009] [Accepted: 11/11/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Severe atherosclerosis of the ascending aorta is a challenging issue potentially affecting indications for surgery, operative choices, and patients' outcome. No standard treatment has emerged to date, and uncertainties persist about criteria for selecting patients and procedures. METHODS Replacement of the atherosclerotic ascending aorta was performed in 64 patients at time of either aortic (n = 49), mitral (n = 21), or tricuspid (n = 7) valve surgery. Coronary artery bypass grafting was performed in 53 patients, and the majority of patients underwent combined procedures (n = 49). Mean age was 72.0 +/- 7.6 years. The expected operative mortality, by logistic European System for Cardiac Operative Risk Evaluation, was 29.0% accounting for ascending aortic replacement and 13.1% disregarding it. Circulatory arrest under deep hypothermia, eventually combined with either retrograde or antegrade brain perfusion, was required in 61 cases. RESULTS Early death, stroke, and myocardial infarction rates were 10.9%, 6.3%, and 7.8%, respectively. Factors univariately associated with early deaths were preoperative renal failure requiring dialysis (p = 0.001) and longer cardiopulmonary bypass (p = 0.001) and cardioplegia (p = 0.008) times. Cumulative survival at 1, 3, and 5 years was 86% +/- 4%, 74% +/- 6%, and 68% +/- 8%, respectively. CONCLUSIONS Replacement of the atherosclerotic ascending aorta can be carried out at acceptable mortality rates despite the high rates of preoperative comorbidity and the significant incidence of postoperative complications.
Collapse
Affiliation(s)
- Bartolo Zingone
- Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
| | | | | | | | | | | | | |
Collapse
|
12
|
Amounts of aortic atherosclerosis in patients with aortic stenosis as determined by transesophageal echocardiography. Am J Cardiol 2009; 103:713-7. [PMID: 19231339 DOI: 10.1016/j.amjcard.2008.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Revised: 11/09/2008] [Accepted: 11/09/2008] [Indexed: 11/20/2022]
Abstract
We quantified the graded amounts of aortic atherosclerosis (AA) in patients with aortic stenosis (AS) to better delineate the need for preprocedural risk stratification. Complex AA is strongly related to embolic events, especially during open heart surgery and catheterization. Despite the frequency of these procedures in patients with AS and the increased prevalence of atherosclerosis, current guidelines do not recommend screening for AA. Patients with concomitant transesophageal and transthoracic echocardiograms were retrospectively identified. AS and AA were graded by expert reviewers as mild, moderate, and severe according to established guidelines. Three hundred sixty patients (212 men, mean age 69 +/- 14 years) were identified, 186 (52%) without AS, 82 (23%) with mild AS, 55 (15%) with moderate AS, and 37 (10%) with severe AS. There was a strong graded positive association between AA and AS (p <0.00001). The prevalence of severe AA increased across grades of AS. Of all patients with severe AS, 54% had severe AA. Of patients with severe AS not referred for an embolic event, 57% had severe AA. The odds ratio for severe AA was 4.9 (95% confidence interval 2.3 to 10.3) in patients with severe AS compared with without AS. In conclusion, AS and AA are closely correlated. The majority of patients with severe AS have severe AA, even without previous thromboembolic events. This significant atherosclerotic burden may warrant preprocedural risk assessment with transesophageal echocardiography.
Collapse
|
13
|
Invited commentary. Ann Thorac Surg 2008; 85:119. [DOI: 10.1016/j.athoracsur.2007.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 09/18/2007] [Accepted: 09/19/2007] [Indexed: 11/19/2022]
|