Calcification of surgical aortic bioprostheses and its impact on clinical outcome
Guillaume Guimbretière
(1, 2)
,
Thomas Sénage
(2, 3)
,
Anne-Sophie Boureau
(2, 1)
,
Jean-Charles Roos
(2, 1)
,
Quentin Bernard
(2, 1)
,
Baptiste Carlier
(2, 1)
,
Joelle Veziers
(4, 2, 5)
,
Caroline Cueff
(1, 2)
,
Nicolas Piriou
(1, 2)
,
Guenola Coste
(1, 2)
,
Imen Fellah
(2, 1)
,
Coline Lelarge
(2, 1)
,
Romain Capoulade
(1, 2)
,
Philippe Jaafar
(1, 2)
,
Thibaud Manigold
(1, 2)
,
Vincent Letocart
(2, 1)
,
Karine Warin-Fresse
(2, 1)
,
Patrice Guérin
(2, 1)
,
Cristina Costa
(6, 7)
,
Marta Vadori
(8)
,
Manuel Galinañes
(9, 10)
,
Rafael Manez
(6, 7)
,
Jean-Paul Soulillou
(11, 12)
,
Emanuele Cozzi
(8)
,
Vered Padler-Karavani
(13)
,
Jean-Michel Serfaty
(1, 2)
,
Jean-Christian Roussel
(1, 2)
,
Thierry Le Tourneau
(1, 2)
1
ITX-lab -
ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291
2 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
3 SPHERE - MethodS in Patients-centered outcomes and HEalth ResEarch
4 RMeS - Regenerative Medicine and Skeleton
5 Nantes Univ - SFR François Bonamy - Structure fédérative de recherche François Bonamy
6 IDIBELL - Institut d'Investigació Biomèdica de Bellvitge = Bellvitge Biomedical Research Institute
7 L’Hospitalet de Llobregat [Barcelona, Spain]
8 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
9 Vall d'Hebron University Hospital [Barcelona]
10 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
11 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
12 ITERT - Institut de Transplantation et de Recherche en Transplantation [CHU Nantes]
13 TAU - Tel Aviv University
2 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
3 SPHERE - MethodS in Patients-centered outcomes and HEalth ResEarch
4 RMeS - Regenerative Medicine and Skeleton
5 Nantes Univ - SFR François Bonamy - Structure fédérative de recherche François Bonamy
6 IDIBELL - Institut d'Investigació Biomèdica de Bellvitge = Bellvitge Biomedical Research Institute
7 L’Hospitalet de Llobregat [Barcelona, Spain]
8 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
9 Vall d'Hebron University Hospital [Barcelona]
10 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
11 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
12 ITERT - Institut de Transplantation et de Recherche en Transplantation [CHU Nantes]
13 TAU - Tel Aviv University
Thomas Sénage
- Fonction : Auteur
- PersonId : 1388573
- ORCID : 0000-0001-8203-0454
- IdRef : 157867684
Romain Capoulade
- Fonction : Auteur
- PersonId : 1159941
- ORCID : 0000-0002-7233-7409
Patrice Guérin
- Fonction : Auteur
- PersonId : 1344910
- ORCID : 0000-0002-8095-8897
Jean-Christian Roussel
- Fonction : Auteur
- PersonId : 1209462
- ORCID : 0000-0003-3928-6977
Thierry Le Tourneau
- Fonction : Auteur
- PersonId : 1210046
- ORCID : 0000-0002-0110-9054
Résumé
Aims : Aortic valve calcification (AVC) of surgical valve bioprostheses (BPs) has been poorly explored. We aimed to evaluate in vivo and ex vivo BP AVCs and its prognosis value.
Methods and results : Between 2011 and 2019, AVC was assessed using in vivo computed tomography (CT) in 361 patients who had undergone surgical valve replacement 6.4 ± 4.3 years earlier. Ex vivo CT scans were performed for 37 explanted BPs. The in vivo CT scans were interpretable for 342 patients (19 patients [5.2%] were excluded). These patients were 77.2 ± 9.1 years old, and 64.3% were male. Mean in vivo AVC was 307 ± 500 Agatston units (AU). The AVC was 562 ± 570 AU for the 183 (53.5%) patients with structural valve degeneration (SVD) and 13 ± 43 AU for those without SVD (P < 0.0001). In vivo and ex vivo AVCs were strongly correlated (r = 0.88, P < 0.0001). An in vivo AVC > 100 AU (n = 147, 43%) had a specificity of 96% for diagnosing Stage 2–3 SVD (area under the curve = 0.92). Patients with AVC > 100 AU had a worse outcome compared with those with AVC ≤ 100 AU (n = 195). In multivariable analysis, AVC was a predictor of overall mortality (hazard ratio [HR] and 95% confidence interval = 1.16 [1.04–1.29]; P = 0.006), cardiovascular mortality (HR = 1.22 [1.04–1.43]; P = 0.013), cardiovascular events (HR = 1.28 [1.16–1.41]; P < 0.0001), and re-intervention (HR = 1.15 [1.06–1.25]; P < 0.0001). After adjustment for Stage 2–3 SVD diagnosis, AVC remained a predictor of overall mortality (HR = 1.20 [1.04–1.39]; P = 0.015) and cardiovascular events (HR = 1.25 [1.09–1.43]; P = 0.001).
Conclusion : CT scan is a reliable tool to assess BP leaflet calcification. An AVC > 100 AU is tightly associated with SVD and it is a strong predictor of overall mortality and cardiovascular events.