Document Detail

Rate of progression and functional significance of aortic root calcification after homograft versus freestyle aortic root replacement.
MedLine Citation:
PMID:  19752378     Owner:  NLM     Status:  MEDLINE    
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.
Ismail El-Hamamsy; Mohamed Zaki; Louis M Stevens; Lucy A Clark; Michael Rubens; Giovanni Melina; Magdi H Yacoub
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  120     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-15     Completed Date:  2009-10-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S269-75     Citation Subset:  AIM; IM    
Department of Cardiac Surgery, Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, UK.
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MeSH Terms
Aortic Valve / physiopathology,  surgery*
Bioprosthesis / adverse effects*
Calcinosis / etiology*
Calcium / metabolism
Disease Progression
Heart Valve Prosthesis Implantation / adverse effects*
Middle Aged
Prospective Studies
Transplantation, Homologous
Ventricular Function
Reg. No./Substance:

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