Endovascular Repair of Blunt Thoracic Aortic Trauma is Associated With Increased Left Ventricular Mass, Hypertension, and Off-target Aortic Remodeling
| Autor: | Anastasia Desyatova, Jason N. MacTaggart, Christopher S. Wichman, Alexey Kamenskiy, Matthew DeVries, Paul Aylward |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Cardiac function curve
Adult Male medicine.medical_specialty Adolescent Computed Tomography Angiography Aorta Thoracic Vascular Remodeling Wounds Nonpenetrating Article 03 medical and health sciences Electrocardiography 0302 clinical medicine Afterload medicine.artery Internal medicine Ascending aorta medicine Thoracic aorta Humans Mass index Child Computed tomography angiography Aged Aorta medicine.diagnostic_test business.industry Endovascular Procedures Nebraska Middle Aged Coronary arteries medicine.anatomical_structure 030220 oncology & carcinogenesis Hypertension Cardiology cardiovascular system 030211 gastroenterology & hepatology Surgery Female Hypertrophy Left Ventricular business |
| Zdroj: | Ann Surg |
| ISSN: | 1528-1140 |
| Popis: | Background Aortic elasticity creates a cushion that protects the heart from pressure injury, and a recoil that helps perfuse the coronary arteries. TEVAR has become first-line therapy for many aortic pathologies including trauma, but stent-grafts stiffen the aorta and likely increase LV afterload. Objective Test the hypothesis that trauma TEVAR is associated with LV mass increase and adverse off-target aortic remodeling. Methods Computed Tomography Angiography (CTA) scans of 20 trauma TEVAR patients (17 M/3 F) at baseline [age 34.9 ± 18.5 (11.4-71.5) years] and 5.1 ± 3.1 (1.1-12.3) years after repair were used to measure changes in LV mass, LV mass index, and diameters and lengths of the ascending thoracic aorta (ATA). Measurements were compared with similarly-aged control patients without aortic repair (21 M/21 F) evaluated at similar follow-ups. Results LV mass and LV mass index of TEVAR patients increased from 138.5 ± 39.6 g and 72.35 ± 15.17 g/m to 173.5 ± 50.1 g and 85.48 ± 18.34 g/m at the rate of 10.03 ± 12.79 g/yr and 6.25 ± 10.28 g/m/yr, whereas in control patients LV characteristics did not change. ATA diameters of TEVAR patients increased at a rate of 0.60 ± 0.80 mm/yr, which was 2.4-fold faster than in controls. ATA length in both TEVAR and control patients increased at 0.58 mm/yr. Half of TEVAR patients had hypertension at follow-up compared to only 5% at baseline. Conclusions TEVAR is associated with LV mass increase, development of hypertension, and accelerated expansile remodeling of the ascending aorta. Although younger trauma patients may adapt to these effects, these changes may be even more important in older patients with other aortic pathologies and diminished baseline cardiac function. |
| Databáze: | OpenAIRE |
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