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Thoracic aortic arteriosclerosis in patients with degenerative aortic stenosis with and without coexisting coronary

Sorel Goland1, Alfredo Trento, Lawrence S C Czer

  • 1Division of Cardiology, Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.

The Annals of Thoracic Surgery
|December 25, 2007
PubMed

Insights

Patients with severe aortic stenosis and coronary artery disease have more extensive thoracic aortic arteriosclerosis. This highlights the need for preoperative thoracic aorta evaluation and aggressive lipid therapy in these patients.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • The association between thoracic aortic arteriosclerosis severity and concomitant coronary artery disease (CAD) in patients with isolated aortic stenosis (AS) remains unevaluated.
  • This study aimed to compare thoracic aortic atheroma extent and severity in severe AS patients with and without concomitant CAD.

Purpose of the Study:

  • To compare thoracic aortic atheroma extent and severity in patients with severe aortic stenosis (AS) alone versus those with AS and concomitant coronary artery disease (CAD).
  • To assess the prevalence and morphology of aortic atheroma in different segments of the thoracic aorta using intraoperative transesophageal echocardiography.

Main Methods:

  • Retrospective evaluation of echocardiograms from 105 patients with severe degenerative AS undergoing aortic valve replacement.
  • Comparison of 60 patients with AS/CAD and 45 with AS alone against 54 control subjects without AS or CAD.
  • Assessment of aortic atheroma prevalence, morphology, and extension across three aortic segments via echocardiography.

Main Results:

  • Patients with AS/CAD exhibited significantly higher rates of aortic root calcification and atheroma in the ascending aorta, aortic arch, and descending aorta compared to AS alone and control groups.
  • AS/CAD patients presented with more complex atheromas in the aortic arch.
  • A greater extension of aortic arteriosclerosis (plaques in two or three segments) was observed in the AS/CAD group.

Conclusions:

  • Severe AS patients with coexisting CAD demonstrate more extensive arteriosclerotic changes in the thoracic aorta.
  • Preoperative evaluation of the thoracic aorta is recommended for patients with severe AS and CAD.
  • Consideration of more aggressive lipid therapy is advised for patients with severe AS and concomitant CAD.
Abstract

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