In Vitro Evaluation of Upstream and Downstream Influences on Blood Pressure of the Hybrid Treatment of Thoracoabdominal Aortic Aneurysms

Spinella, Giovanni; Pane, Bianca; Bonfiglio, Andrea; Musio, Debora; Perfumo, Maria Cecilia; Gazzola, Valerio; Stocchino, Alessandro; Palombo, Domenico

doi:10.1016/j.avsg.2016.06.003

Cited by 4 publications

(2 citation statements)

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“…Indeed, the stiffness of the stent-graft is known to modify the aortic compliance and alters both forward transmission and backward reflection of the sphygmic wave. [6][7][8][9][10][11] This interference could potentially affect the systolic afterload to left ventricular (LV) contraction and the coronary driving pressure pattern, and altering myocardial perfusion response to physical or emotional stresses, especially in patients with co-existing coronary artery disease (CAD). [12][13][14] From the methodological point of view, the altered transmission of the pressure wave hampers the accuracy of the clinical evaluation of LV function by the ejection fraction (EF), since the uncertain pressure at the aortic valve (AV) does not permit to correctly account for the vascular resistance to systolic output.…”

Section: Introductionmentioning

confidence: 99%

“…Although the underlying mechanisms still need to be cleared, the haemodynamic consequence of EVAR might contribute to the risk of cardiac events. Indeed, the stiffness of the stent‐graft is known to modify the aortic compliance and alters both forward transmission and backward reflection of the sphygmic wave 6–11 . This interference could potentially affect the systolic afterload to left ventricular (LV) contraction and the coronary driving pressure pattern, and altering myocardial perfusion response to physical or emotional stresses, especially in patients with co‐existing coronary artery disease (CAD) 12–14 …”

Section: Introductionmentioning

confidence: 99%

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Endovascular aortic repair impact on myocardial contractility: A prospective study

Spinella

Boschetti

Bauckneht

et al. 2023

Eur J Clin Investigation

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BackgroundThis study aimed to estimate if the altered sphygmic wave transmission may affect the left ventricular (LV) contractile function in patients undergoing endovascular aortic repair (EVAR).MethodsA prospective single‐centre study was carried out on consecutive patients undergoing EVAR for abdominal aortic aneurysm. A preoperative and 6‐month single photon emission computed tomography (SPECT) with arterial stiffness measurement were performed to evaluate variations in pressure wave curve and myocardial perfusion parameters.ResultsFrom 2018 to 2020 a total of 16 patients were included in the study. Among the parameters evaluated, we found a measurable reduction of the reflected wave transit time from pre‐ to postoperative period, for both stress (115.13 ± 7.2 ms–111.1 ± 7.0 ms, p = .08) and rest SPECT acquisitions (115.3 ± 6.2 ms–112.2 ± 5.6 ms, p = .1). Unidirectional increase of both LV end‐systolic volume (34 ± 9 mL–39 ± 8 mL, p = .02) and end‐diastolic volume (85 ± 34 mL–89 ± 29 mL, p = .6) was also observed. Lastly, the ratio between the end‐systolic pressure and the end‐systolic volume (maximal systolic myocardial stiffness) decreased from 3.6 ± 1.5 mmHg/mL to 2.66 ± .74 mmHg/mL (p = .03).ConclusionsOur data showed that EVAR induced an altered transmission of the sphygmic wave associated with an early LV contractile impairment.

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