gms | German Medical Science

Background: Pulse wave velocity, which is a measure for aortic stiffness, is a well-known factor associated with cardiovascular event. It is also known to increase after aortic repair. The purpose of this study was to evaluate the changes in pulse wave velocity in patients undergoing stent graft treatment for aortic arch aneurysm. Changes in left ventricular dimensions and long-term outcomes were also evaluated.

Methods: From July 2008 to February 2019, 86 patients underwent thoracic endovascular aortic repair of an aortic arch aneurysm. Among them, 26 patients were treated by exoskeleton type stent graft and 60 patients were treated by endoskeleton type stent graft. Changes in pulse wave velocity, echocardiogram findings, and long-term outcomes were compared between two different types of stent graft used. The result of this study has been published in Gen Thorac Cardiovasc Surg [1].

Results: There were no significant differences in patient demographics except for diabetes which was more often observed in patients receiving endoskeleton type stent graft (Endoskeleton: 26.7% vs. Exoskeleton: 3.9%, p=0.017). There was a significant increase in pulse wave velocity in patients receiving exoskeleton type stent graft after surgery, which further progressed at median follow up of 32 months (Before: 2047 ± 415.8 cm/s vs. After: 2259 ± 514.6 cm/s vs. Follow-up: 2486 ± 610.2 cm/s, p=0.010, p=0.017). No significant difference was observed in endoskeleton type stent graft (Before: 1980 ± 354.9 cm/s vs. After: 2058 ± 443.5 cm/s, vs. Follow-up: 2042 ± 401.7 cm/s, p=0.25, p=0.34). Echocardiogram performed at median period of 46.3 months revealed 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 patients receiving exoskeleton type stent graft. No significant change was observed in LVDV (Before: 102.6 ± 32.3 ml vs. Follow-up: 96.9 ± 35.4 ml, p=0.74) and e’ (Before: 4.4 ± 1.21 cm/s vs. Follow-up: 4.8 ± 1.40 cm/s, p=0.68) in patients receiving endoskeleton type stent graft. At median period of 61.3 months, there was no significant difference in long-term mortality (p=0.89). However, endoskeleton type was associated with lower incidence of cardiac event (p=0.034) and cerebrovascular event (p=0.029).

Conclusion: Endovascular treatment provides minimal invasive aortic repair for patients with aortic aneurysm. Although exclusion of aneurysm is the primary goal, physiological changes should also be considered. Selection of endoprosthesis may be one option to reduce the risk of increased pulse wave velocity and its accommodated complications after surgery.