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Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

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Theodorus M.J. van Bakel, Christopher J. Arthurs, Foeke J.H. Nauta, Kim A. Eagle, Joost A. van Herwaarden, Frans L. Moll, Santi Trimarchi, Himanshu J. Patel, C. Alberto Figueroa

Original languageEnglish
Pages (from-to)1061-1070
Number of pages10
JournalEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume55
Issue number6
Early online date6 Dec 2018
DOIs
Accepted/In press29 Oct 2018
E-pub ahead of print6 Dec 2018
PublishedJun 2019

King's Authors

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.

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