Changes in Arterial Stiffness and N-Terminal Pro-Brain Natriuretic Peptide Levels after Endovascular Repair of Descending Thoracic Aorta

Zahedi, Abolfazl; Ebrahimi, Milad

doi:10.1016/j.avsg.2018.01.066

Cited by 1 publication

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“…Emerging clinical evidence demonstrates increased vascular stiffness and LV mass, along with decreased exercise tolerance in patients with stiff aortic grafts and stent-grafts 9,17,26,27,33–35 . Our current analysis supports these concerns demonstrating a substantial increase in LV mass and LVMi in TEVAR patients at the rate of 10.03 g/yr and 6.25 g/m 2 /yr, compared to no change in the LV characteristics in similarly-aged control subjects.…”

Section: Discussionsupporting

confidence: 79%

“…9 As the aorta stiffens with age, [10][11][12] higher ventricular forces are required to distend the aortic wall and this may contribute to increases in systolic blood pressure, [13][14][15] pulse wave velocity, and LV afterload, [16][17][18][19][20] that may lead to LV hypertrophy and fibrosis, eventually culminating in contractile dysfunction and cardiomyopathy. [21][22][23] Because both ePTFE and PET materials used in conventional stent-grafts are substantially stiffer than aortic wall, 24 their implantation stiffens 17,[25][26][27] and effectively ages the aorta. Standard metrics used to assess stent-graft performance typically include shorter-term morbidity, mortality, and local complications requiring re-intervention, 28 but rarely have data been reported on the cardiac and off-target aortic effects of TEVAR.…”

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confidence: 99%

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Endovascular Repair of Blunt Thoracic Aortic Trauma is Associated With Increased Left Ventricular Mass, Hypertension, and Off-target Aortic Remodeling

et al. 2020

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Background: Aortic elasticity creates a cushion that protects the heart from pressure injury, and a recoil that helps perfuse the coronary arteries. TEVAR has become first-line therapy for many aortic pathologies including trauma, but stent-grafts stiffen the aorta and likely increase LV afterload. Objective: Test the hypothesis that trauma TEVAR is associated with LV mass increase and adverse off-target aortic remodeling. Methods: Computed Tomography Angiography (CTA) scans of 20 trauma TEVAR patients (17 M/3 F) at baseline ) years] and 5.1 AE 3.1 (1.1-12.3) years after repair were used to measure changes in LV mass, LV mass index, and diameters and lengths of the ascending thoracic aorta (ATA). Measurements were compared with similarly-aged control patients without aortic repair (21 M/21 F) evaluated at similar follow-ups. Results: LV mass and LV mass index of TEVAR patients increased from 138.5 AE 39.6 g and 72.35 AE 15.17 g/m 2 to 173.5 AE 50.1 g and 85.48 AE 18.34 g/ m 2 at the rate of 10.03 AE 12.79 g/yr and 6.25 AE 10.28 g/m 2 /yr, whereas in control patients LV characteristics did not change. ATA diameters of TEVAR patients increased at a rate of 0.60 AE 0.80 mm/yr, which was 2.4-fold faster than in controls. ATA length in both TEVAR and control patients increased at 0.58 mm/yr. Half of TEVAR patients had hypertension at follow-up compared to only 5% at baseline. Conclusions: TEVAR is associated with LV mass increase, development of hypertension, and accelerated expansile remodeling of the ascending aorta. Although younger trauma patients may adapt to these effects, these changes may be even more important in older patients with other aortic pathologies and diminished baseline cardiac function.

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Section: Discussionsupporting

confidence: 79%