CALA: Cumulative Volume of Calcium Lesions of the Ascending Aorta and Aortic Arch Correlate with Early Mortality, Critical Illness Polyneuropathy/Myopathy, and Delirium but Not with Stroke

Objectives: Stroke is one of the major postoperative complications in cardiac surgery. Depending on the surgical procedures performed the incidence of stroke ranges from 1 to 4%. The aim of this retrospective study was to examine the role of calcified plaques within the ascending aorta and aortic arch in the prevalence of this adverse event by performing different surgical procedures such as CABG, AVR, MVR, TVR, and complex procedures like multivalve repair or replacement with CABG as well as wrapping of ascending aorta.

Methods: Data for this study were retrospectively collected from 795 patients whose calcified plaque volume of the ascending aorta and aortic arch was determined from routinely performed unenhanced low-dose CT scans. Using a threshold of 130 Hounsfield units, the cumulative volume of calcified lesions was calculated. These results were then correlated with clamping strategies, prevalence of postoperative stroke, all-cause in-hospital mortality, critical illness polyneuropathy/critical illness myopathy (CIP/CIM), and delirium.

Result: In 795 patients, 2.3% had a stroke, 8.6% died in hospital, 4.9% had CIP/CIM, and 15.1% suffered from a delirium. Statistical analyses revealed no significant correlation between the average values of plaque volume between patients with stroke or without stroke (p = 0.22; 95% confidence level [CL]). However, plaque volumes were significantly higher in patients who deceased due to all causes of in-hospital mortality (p = 0.003, at 95% CL), suffered from (CIP/CIM) (p = 0.03, at 95% CL) or experienced a delirium (p ≤ 0.001, at 95% CL). A further and more in-depth statistical analysis of the primary outcomes regarding the different operative techniques was performed. There were no significant differences between isolated cross-clamping (n = 175) versus cross-clamping plus consecutive partial clamping of the aorta (n = 359) regarding the primary adverse events by means of mean plaque volume. Furthermore, neither the prevalence of stroke (p = 0.40, at 95% CL) nor all-cause in-hospital mortality (p = 0.41, at 95% CL), CIP/CIM (p = 0.09, at 95% CL) or delirium (p = 0.10, at 95% CL) differed significantly between the two surgical methods.

Conclusion: In this retrospective study, clamping strategies as well as stroke did not correlate with elevated plaque volume. In contrast, all-cause in-hospital mortality, CIP/CIM, and delirium are associated with increased plaque volume. Plaque volume may thus rather serve as a general predictive parameter for an adverse outcome or as a predictive tool for an individualized tactical operative planning.

Publication History

Article published online:
19 February 2021