2.2: Heart Structure and Vascular Function in Young Patients After Endovascular Repair for Blunt Thoracic Aortic Injury

Abstract

Objective

Thoracic Endovascular Aortic Repair (TEVAR) currently represents the gold standard of treatment for Blunt Thoracic Aortic Injury (BTAI). Nevertheless, there is an ongoing debate surrounding its safety and efficacy and its subsequent CV effects. The present study is aimed at assessing heart and aortic structure and function after TEVAR in BTAI patients

Method

In 20 patients (18 men, age 41 ± 14 years) treated with TEVAR (11 Gore-CTAG, 9 Medtronic-Valiant) after BTAI, between 2004–2015, after a median follow-up time of 3 years (range 12–1 years; T1) we evaluated BP, cf-PWV (sphygmocor) and Left Ventricular Mass Index (LVMI) on echocardiography.

Results

At baseline, all the patients were normotensive; At T1 despite mean normal BP value (131 ± 12/85 ± 10) 11 patients (55%) were hypertensives. Also LVMI (81,84 ± 28,11 g/m²) and PWV (7,58 ± 1,48 m/s) mean values were within the normal range. When patients were divided accordingly to the used graft patients treated with Medtronic-Valiant showed a significantly higher LVMI (97.17 ± 35.78 vs 69.58 ± 11.24 g/m²; p < 0,05) and PWV (7,78 ± 1,74 vs 6,45 ± 1,54 m/s; p < 0,05) compared with those treated with Gore-CTAG. Same figures were founded when patients were divided accordingly to the treating time with those treated more than 3 years before the evaluation that showed higher LVMI (91,16 ± 34,73 vs 70,20 ± 9,44 g/m²; p < 0,01) and PWV (7,50 ± 1,98 vs 6,38 ± 1,04 m/s; p < 0,05).

Conclusions

TEVAR for BTAI is associated after some years with the development of hypertension and heart and vascular alterations. The presence of TEVAR modify aortic functional properties and induce in young subject an increase in BP and LVMI probably related to the presence of a rigid aorta.