| Title | Rate of progression and functional significance of aortic root calcification after homograft versus freestyle aortic root replacement. | | Author(s) | El-Hamamsy I, Zaki M, Stevens LM, Clark LA, Rubens M, Melina G, Yacoub MH | | Institution | Department of Cardiac Surgery, Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, UK. | | Source | Circulation 2009 Sep 15; 120(11 Suppl):S269-75. | | MeSH | Aged
Aortic Valve
Bioprosthesis
Calcinosis
Calcium
Disease Progression
Female
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Prospective Studies
Reoperation
Transplantation, Homologous
Ventricular Function
| | Abstract | BACKGROUND: Calcification is an important limitation after aortic root replacement. The aims were to compare the long-term degree and rate of calcification of homografts versus Medtronic freestyle aortic roots to determine the functional consequences and predictive factors.
METHODS AND RESULTS: One hundred sixty-six patients were prospectively randomized to undergo homograft versus freestyle total aortic root replacement. Of those, 98 patients underwent a total of 248 electron beam computed tomography studies at 0.5, 1, 1.5, 2, 3, and 8 years. All patients underwent yearly clinical and echocardiographic follow-up. Calcium scores were measured using Agatston scoring. Mixed effects models demonstrate significantly higher calcium scores in homograft roots than freestyle at 1.5 years (P=0.02), 2 years (P=0.02), and 3 years (P=0.01), with a trend at 1 year (P=0.06) and 8 years (P=0.1). Homograft calcification occurs significantly faster than in freestyle prostheses between 6 months and 3 years after surgery (P=0.02). Calcification occurs at a similar rate thereafter up to 8 years (P=0.3). At 8 years, freedom from aortic valve dysfunction was lower in homografts than freestyle roots (P=0.06). Freedom from reoperation was 93+/-4% in the homograft group versus 100+/-0% in the freestyle group at 8 years (P=0.01). On multivariate analysis, redo surgery (P<0.001), smoking (P<0.01), atrial fibrillation (P=0.001), family history of coronary artery disease (P<0.01), and a degenerative etiology (P=0.02) were predictive of higher calcium scores.
CONCLUSIONS: Homograft roots exhibit significantly higher calcium scores than freestyle roots because of faster early calcification. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
| | PubMed ID | 19752378 |
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