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Preoperative Evaluation of Aortic Calcification by Computed Tomography in Thoracic Aortic Disease
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  • Ryo Suzuki,
  • Akihito Mikamo,
  • Sari Tsubone,
  • Kazumasa Matsunaga,
  • Yuutaro Matsuno,
  • Hiroshi Kurazumi,
  • Kimikazu Hamano
Ryo Suzuki
Yamaguchi University School of Medicine
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Akihito Mikamo
Yamaguchi University School of Medicine
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Sari Tsubone
Yamaguchi University School of Medicine
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Kazumasa Matsunaga
Yamaguchi University School of Medicine
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Yuutaro Matsuno
Yamaguchi University School of Medicine
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Hiroshi Kurazumi
Yamaguchi University School of Medicine
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Kimikazu Hamano
Yamaguchi University School of Medicine
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Peer review status:UNDER REVIEW

26 Jul 2020Submitted to Journal of Cardiac Surgery
27 Jul 2020Assigned to Editor
27 Jul 2020Submission Checks Completed
27 Jul 2020Reviewer(s) Assigned

Abstract

Background: Computed tomography (CT) is a useful tool for the identification of calcified lesions in the aorta. However, no quantitative evaluation has been established to assess the applicability of simple anastomosis preoperatively. We conducted this retrospective study to establish a reference range of the maximal CT value for application of simple anastomosis. Methods: 122 consecutive patients underwent replacement of the thoracic aorta between 2007-2011, excluding those with acute aortic dissection. The patients were divided into two groups: those who could undergo simple anastomosis (Simple group:n=105), and those who required endarterectomy prior to anastomosis (Manipulation group:n=17). The maximal CT value at the anastomosis site was calculated by an imaging software. Results: The mean maximal CT value (Hounsfield unit: HU) was significantly higher in the Manipulation group (638.1 ± 269.5 [166-1304]) than in the Simple group (94.7 ± 171.5 [0-790]) (p<0.0001). The maximal CT value enabled us to predict the simple anastomosis with the area under the receiver operating characteristic curve of 0.96 (p<0.0001). The cut-off value was 325 HU (sensitivity 94.1%, specificity 81.7%). The 10-year survival rate was significant lower in the Manupilation group (11.8%) than in the Simple group (43.2%). In the multivariate analysis, age (Hazard Ratio [HR]:1.073), Hypertension (HR:2.382) and maximal CT value (HR:1.001) were independently associated with long-term mortality. Conclusions: Preoperative evaluation of the maximal CT value is a useful tool in predicting whether simple anastomosis is applicable or not, in the thoracic aortic surgery. Maximal CT value is a risk factor for long-term mortality.