Aortic valve calcification of surgical bioprostheses and its impact on clinical outcome

G. Guimbretiere, T. Senage, A.S. Boureau, N. Piriou, K. Warin-Fresse, J.M. Serfaty, J.C. Roussel, T. Le Tourneau
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Abstract

Introduction

Aortic valve calcification (AVC) of surgical valve bioprostheses (BP) has been poorly explored. We aimed to evaluate in vivo and ex vivo BP AVC and its prognosis value.

Method

Between 2011 and 2019, AVC was assessed in 361 patients with surgical BP on in vivo computed tomography (CT) scanner (6.4 ± 4.3 years after surgery). Follow-up was obtained in all patients. Ex vivo CT-scans were performed in 37 explanted BP.

Results

After exclusion of 19 (5.2%) CT-scans, mean in vivo AVC was 307 ± 500 AU in the remaining 342 BP (77 ± 9 years, 64% male). Of these, 183 (53.5%) had a structural valve degeneration (SVD) with an AVC of 562 ± 570 AU compared with 13 ± 43 AU (P < 0.0001) for non-SVD BP. Early calcification was observed in around 10% of BP (12/124) examined before the 3rd postoperative year. In explanted BP in vivo AVC correlated strongly with ex vivo AVC (r = 0.88, P < 0.0001). An in vivo AVC > 100 AU (n = 147, 43%) had an excellent specificity (96%) for diagnosing stage 2–3 SVD. Patients with AVC > 100 AU had worse survival compared with those with an AVC < 100 (n = 195, 57%). In multivariable analyses, AVC value was a predictor of overall mortality (HR = 1.16 [1.04–1.29]; P = 0.009), cardiovascular mortality (HR = 1.21 [1.03–1.41]; P = 0.021) and cardiovascular events (HR = 1.19 [1.08–1.31]; P = 0.001). After further adjustment for SVD diagnosis, AVC remained a predictor of overall mortality (HR = 1.24 [1.07–1.44]; P = 0.005), and cardiovascular events (HR = 1.16 [1.02–1.32]; P = 0.029).

Conclusion

CT-scan AVC of surgical BP is a reliable tool for assessing leaflets calcification. Whereas calcification can develop early after surgery, an AVC > 100 AU is tightly associated with SVD, and is a strong predictor of overall mortality and cardiovascular events, even after adjustment for SVD diagnosis. Hence, AVC scoring is a complementary tool to echocardiography that should be used in the follow-up of patients with surgical aortic BP.

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外科生物瓣膜的主动脉瓣钙化及其对临床结果的影响
外科生物瓣膜修复术(BP)主动脉瓣钙化(AVC)的研究很少。我们的目的是评估体内和离体BP AVC及其预后价值。方法对2011年至2019年361例外科BP患者(术后6.4±4.3年)进行AVC评估。所有患者均接受随访。对37例BP进行体外ct扫描。结果排除19例(5.2%)ct扫描后,剩余342 BP(77±9岁,男性64%)的平均体内AVC为307±500 AU。其中183例(53.5%)有结构性瓣膜变性(SVD), AVC为562±570 AU,而AVC为13±43 AU (P <0.0001)。术后3年前检查的BP(12/124)中约有10%出现早期钙化。外植BP体内AVC与离体AVC呈显著相关(r = 0.88, P <0.0001)。体内AVC >100 AU (n = 147, 43%)诊断2-3期SVD具有极好的特异性(96%)。AVC患者;100 AU患者的生存率较AVC患者差;100 (n = 195, 57%)。在多变量分析中,AVC值是总死亡率的预测因子(HR = 1.16 [1.04-1.29];P = 0.009),心血管死亡率(HR = 1.21 [1.03-1.41];P = 0.021)和心血管事件(HR = 1.19 [1.08-1.31];p = 0.001)。在进一步调整SVD诊断后,AVC仍然是总死亡率的预测因子(HR = 1.24 [1.07-1.44];P = 0.005),心血管事件(HR = 1.16 [1.02-1.32];p = 0.029)。结论ct扫描AVC是评估小叶钙化的可靠工具。尽管钙化可以在手术后早期发生,但AVC >100 AU与SVD密切相关,即使在SVD诊断调整后,仍是总死亡率和心血管事件的有力预测因子。因此,AVC评分是超声心动图的补充工具,应用于手术主动脉BP患者的随访。
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来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
0.00%
发文量
508
期刊介绍: Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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