Rate of progression and functional significance of aortic root calcification after homograft versus freestyle aortic root replacement.
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.


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.
El-Hamamsy
Ismail
I
Department of Cardiac Surgery, Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, UK.
Zaki
Mohamed
M
Stevens
Louis M
LM
Clark
Lucy A
LA
Rubens
Michael
M
Melina
Giovanni
G
Yacoub
Magdi H
MH
D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects*; D002114:Calcinosis / Q000209:etiology*; D002118:Calcium / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D014184:Transplantation, Homologous; D016276:Ventricular Function
D002118:Calcium