Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

Abstract

OBJECTIVES Current endografts for thoracic endovascular aortic repair (TEVAR) are much stiffer than the aorta and have been shown to induce acute stiffening. In this study, we aimed to estimate the impact of TEVAR on left ventricular (LV) stroke work (SW) and mass using a non-invasive image-based workflow. METHODS The University of Michigan database was searched for patients treated with TEVAR for descending aortic pathologies (2013–2016). Patients with available pre-TEVAR and post-TEVAR computed tomography angiography and echocardiography data were selected. LV SW was estimated via patient-specific fluid–structure interaction analyses. LV remodelling was quantified through morphological measurements using echocardiography and electrocardiographic-gated computed tomography angiography data. RESULTS Eight subjects were included in this study, the mean age of the patients was 68 (73, 25) years, and 6 patients were women. All patients were prescribed antihypertensive drugs following TEVAR. The fluid–structure interaction simulations computed a 26% increase in LV SW post-TEVAR [0.94 (0.89, 0.34) J to 1.18 (1.11, 0.65) J, P = 0.012]. Morphological measurements revealed an increase in the LV mass index post-TEVAR of +26% in echocardiography [72 (73, 17) g/m2 to 91 (87, 26) g/m2, P = 0.017] and +15% in computed tomography angiography [52 (46, 29) g/m2 to 60 (57, 22) g/m2, P = 0.043]. The post- to pre-TEVAR LV mass index ratio was positively correlated with the post- to pre-TEVAR ratios of SW and the mean blood pressure (ρ = 0.690, P = 0.058 and ρ = 0.786, P = 0.021, respectively). CONCLUSIONS TEVAR was associated with increased LV SW and mass during follow-up. Medical device manufacturers should develop more compliant devices to reduce the stiffness mismatch with the aorta. Additionally, intensive antihypertensive management is needed to control blood pressure post-TEVAR.

Computational analysis of renal artery flow characteristics by modeling aortoplasty and aortic bypass interventions for abdominal aortic coarctation

“…engineering fields that can be applied to study complex flow dynamics. Image-based computational tools have been developed for cardiovascular disease research, 24,25 medical device evaluation and, more recently, virtual planning of surgical interventions. 9 An unexpected finding of this investigation was that most surgical repairs resulted in a reduction in renal artery pressures (Figure 8).…”

Type B intramural hematoma: thoracic endovascular aortic repair (TEVAR) or conservative approach?

“…This increased stiffness of the aorta following stent-graft deployment can increase stresses in the untreated segments of the aortic wall (28). Furthermore, left ventricular stroke work is estimated to increase up to 26% as a consequence of stent-graft induced descending aortic stiffening, resulting in adverse left ventricular remodeling (29).…”

Commentary: When Promising Innovators Lack Strategic Vision: The Concept of Flow Modulation in Aortic Dissection

“…However, trepidation about the long-term effect of extensive aortic coverage on cardiac function has justifiably raised concerns among vascular communities. 12 These apprehensions have encouraged pioneering techniques to reduce aortic coverage while simultaneously promoting remodeling of the entire aorta and maintaining side branch perfusion. The determination to lessen aortic coverage and preserve compliance has been achieved using the s t aged h ybrid sin g le lum e n r econstruction (TIGER) technique.…”

“…The MFM is not a resolution for patients living on borrowed time and must not be used erratically in those patients in whom other modus operandi of aortic repair are not achievable. 10–14…”

“…The MFM is not a resolution for patients living on borrowed time and must not be used erratically in those patients in whom other modus operandi of aortic repair are not achievable. [10][11][12][13][14] Costache et al 1 mirrored the findings of the MFM Global Registry that aortic aneurysms are chronic end-stage diseases in which the MFM cannot induce aortic remodeling once the TAAA diameter exceeds 6.2 cm. However, it does lower the aortic wall stress pressure, and that is why the MFM is suitable only for managing AD.…”