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Eur J Cardiothorac Surg. 2019 Jun 1;55(6):1061-1070. doi: 10.1093/ejcts/ezy399.

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms.

Author information

1
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
2
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
3
Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy.
4
Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
5
Department of Cardiology, University of Michigan, Ann Arbor, MI, USA.
6
Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
7
Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA.
8
Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.

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.

KEYWORDS:

Cardiac remodelling; Computational modelling; Stroke work; Thoracic endovascular aortic repair

PMID:
30535179
PMCID:
PMC6537936
[Available on 2020-06-01]
DOI:
10.1093/ejcts/ezy399

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