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/m(2) to 91 (87, 26) g/m(2), P=0.017] and +15% in computed tomography angiography [52 (46, 29) g/m(2) to 60 (57, 22) g/m(2), 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 (rho=0.690, P=0.058 and rho=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.

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms / T.M.J. van Bakel, C.J. Arthurs, F.J.H. Nauta, K.A. Eagle, J.A. van Herwaarden, F.L. Moll, S. Trimarchi, H.J. Patel, C.A. Figueroa. - In: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. - ISSN 1010-7940. - 55:6(2019 Jun 01), pp. 1061-1070. [10.1093/ejcts/ezy399]

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

S. Trimarchi;
2019

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/m(2) to 91 (87, 26) g/m(2), P=0.017] and +15% in computed tomography angiography [52 (46, 29) g/m(2) to 60 (57, 22) g/m(2), 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 (rho=0.690, P=0.058 and rho=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.
Cardiac remodelling; Computational modelling; Stroke work; Thoracic endovascular aortic repair;
Settore MED/22 - Chirurgia Vascolare
   An Integrated Computer Modelling Framework for Subject-Specific Cardiovascular Simulation: Applications to Disease Research, Treatment Planning, and Medical Device Design
   INTEG-CV-SIM
   European Commission
   SEVENTH FRAMEWORK PROGRAMME
   307532
1-giu-2019
6-dic-2018
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/994353
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