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Quantitative evaluation of superior mesenteric artery calcification in hemodialysis patients undergoing aortic valve
Shuhei Miura1, Yoshihiko Kurimoto2, Yutaka Iba2
1Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan. miura-sh@keijinkai.or.jp.
Insights
Superior mesenteric artery calcification (SMAC) is linked to a higher risk of acute mesenteric ischemia (AMI) and mortality following aortic valve replacement (AVR) in hemodialysis patients. Quantitative SMAC assessment may predict these adverse outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Nephrology
Background:
- Postoperative acute mesenteric ischemia (AMI) is a severe complication in long-term hemodialysis (HD) patients undergoing aortic valve replacement (AVR).
- Superior mesenteric artery calcification (SMAC) may be associated with adverse outcomes in this high-risk population.
Purpose of the Study:
- To evaluate the association between SMAC and early and late outcomes after AVR in HD patients.
- To determine if SMAC is a predictive marker for AMI and mortality post-AVR.
Main Methods:
- Retrospective review of 46 HD patients who underwent AVR for severe aortic valve stenosis.
- Patients were divided into SMAC (n=25) and non-SMAC (n=21) groups based on preoperative CT scans.
- Superior mesenteric artery (SMA) calcification was quantified using the Agaston calcium score.
Main Results:
- The SMAC group exhibited higher rates of AMI (24.0% vs 4.7%) and hospital mortality (16.0% vs 0%) compared to the non-SMAC group.
- SMAC was significantly associated with increased risk of AMI (OR 3.8) and hospital mortality (OR 2.4) in multivariate analysis.
- Higher SMA calcium scores were observed in patients who developed AMI.
Conclusions:
- Quantitative evaluation of SMAC can serve as a predictive marker for AMI incidence after AVR in HD patients.
- Identifying SMAC may help stratify risk and guide management in HD patients undergoing AVR.
Objective:
Postoperative acute mesenteric ischemia (AMI) in the long-term hemodialysis (HD) patients could be a disastrous complication leading to high mortality. The objective is to evaluate the association between the presence of superior mesenteric artery calcification (SMAC) and early and late outcomes after aortic valve replacement (AVR) in HD patients.
Methods:
Between April 2003 and December 2018, the enrolled 46 HD patients (19 women; mean age 72 years) who underwent AVR for severe aortic valve stenosis were retrospectively reviewed. 25 patients (54.3%) who had severe calcifications of superior mesenteric artery (SMA) were defined as the SMAC group, and the calcification extent of SMA was evaluated on preoperative non-contrast CT using Agaston calcium score [calcification area (cm2) × max CT value (HU)]. The operative outcomes were compared with those of the non-SMAC group comprising 21 patients (45.7%).
Results:
The following factors in SMAC group were statistically higher compared with those of the non-SMAC group: age (73.6 ± 7.2 vs 69.3 ± 7.1 years; p = 0.04), celiac artery calcification (76.4% vs 17.6%; p < 0.001), calcium score of SMA (692.3 ± 300.0 vs 123.5 ± 180.7; p < 0.001), the incidence of AMI (24.0% vs 4.7%; p = 0.001), and hospital mortality (16.0% vs 0%; p = 0.02). In multivariate analysis, the presence of SMAC was significantly associated with AMI (OR 3.8, p = 0.05) and hospital mortality (OR 2.4, p = 0.02). Calcium score of SMA in patients complicated with AMI was significantly higher than those without AMI (815.7 ± 300.5 vs 366.9 ± 351.2; p < 0.01).
Conclusion:
Quantitative evaluation of SMAC could be a predictive marker of incidence of AMI after AVR in HD patients.
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