Effect of endoprostheses on pulse wave velocity and its long-term outcomes after thoracic endovascular aortic repair

• Published in: General thoracic and cardiovascular surgery 2020-10, Vol.68 (10), p.1134-1141
• Main Authors: Hori, Daijiro, Yuri, Koichi, Kusadokoro, Sho, Shimizu, Toshikazu, Kimura, Naoyuki, Yamaguchi, Atsushi
• Format: Article
• Language: English
• Subjects: Aged; Aneurysms; Aorta, Thoracic - physiopathology; Aorta, Thoracic - surgery; Blood pressure; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Cardiac Surgery; Cardiology; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Chronic obstructive pulmonary disease; Demographics; Diabetes; Endovascular Procedures - methods; Female; Heart Ventricles - anatomy & histology; Hospitals; Humans; Hypertension; Incidence; Ischemia; Male; Medicine; Medicine & Public Health; Metabolic disorders; Middle Aged; Mortality; Original Article; Patients; Physiology; Postoperative Complications - epidemiology; Prosthesis Design; Pulse Wave Analysis; Risk Factors; Stents; Surgery; Surgical Oncology; Surgical outcomes; Thoracic Surgery; Treatment Outcome; Ultrasonic imaging; Veins & arteries; Velocity; Ventricular Function, Left
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-020-01343-0

Background The purpose of this study was to evaluate the changes in pulse wave velocity and left ventricular dimensions in patients undergoing stent-graft treatment for aortic arch aneurysm. Methods From July 2008 to February 2019, 86 patients underwent thoracic endovascular aortic repair of an aortic arch aneurysm. Changes in pulse wave velocity (PWV), echocardiogram findings, and long-term outcomes were compared between endoskeleton type ( n  = 60) and exoskeleton type stent-graft ( n  = 26). Results There was no significant difference in patient demographics except for diabetes which was more observed in endoskeleton type ( p  = 0.017). There was a significant increase in PWV in exoskeleton type after surgery, which further progressed at a median follow-up of 32 months (before: 2047 cm/s vs. after: 2259 cm/s vs. follow-up: 2486 cm/s, p  = 0.010, p  = 0.017). No significant difference was observed in endoskeleton type (before: 1980 cm/s vs. after: 2058 cm/s, vs. follow-up: 2042 cm/s, p  = 0.25, p  = 0.34). Echocardiogram performed at a median period of 46.3 months, revealed a significant increase in left ventricular diastolic volume (LVDV) (before: 107.4 ± 20.6 ml vs. follow-up: 127.7 ± 27.5 ml, p  = 0.003) and decrease in e ′ (before: 5.5 ± 1.78 cm/s vs. follow-up: 4.7 ± 1.72 cm/s, p  = 0.012) in exoskeleton type, while no significant change was observed in endoskeleton type (LVDV: before: 102.6 ± 32.3 ml vs. follow-up: 96.9 ± 35.4 ml, p  = 0.74; e ′: before: 4.4 ± 1.21 cm/s vs. follow-up: 4.8 ± 1.40 cm/s, p  = 0.68). At the median period of 61.3 months, there was no significant difference in long-term mortality ( p  = 0.89). However, the endoskeleton type was associated with a lower incidence of a cardiac event ( p  = 0.034) and cerebrovascular event ( p  = 0.029). Conclusion Types of endoprosthesis might affect differently on physiological changes and its accommodated risk factors after surgery.