Abstract
ObjectivesThoracic endovascular aortic repair (TEVAR) has been shown to lead to increased aortic stiffness. The aim of this study was to investigate the effect of stent graft type and stent graft length on aortic stiffness in a controlled, experimental setting.MethodsTwenty porcine thoracic aortas were connected to a pulsatile mock loop system. Intraluminal pressure was recorded at two sites in order to measure pulse wave velocity (PWV) for each aorta: before stent graft deployment (t1); after deployment of a 100-mm long stent graft (t2); and after distal extension through deployment of a second 100-mm long stent graft (t3). Four different types of stent grafts (Conformable Gore® TAG® Device, Bolton Relay® Device, Cook Zenith Alpha™, and Medtronic Valiant®) were evaluated.ResultsFor the total cohort of 20 aortas, PWV increased by a mean 0.6 m/s or 8.9% of baseline PWV after deployment of a 100-mm proximal stent graft (P<0.001), and by a mean 1.4 m/s or 23.0% of baseline PWV after distal extension of the stent graft (P<0.001). Univariable regression analysis showed a significant correlation between aortic PWV and extent of stent graft coverage, (P<0.001), but no significant effect of baseline aortic length, baseline aortic PWV, or stent graft type on the percentual increase in PWV at t2 or at t3.ConclusionsIn this experimental set-up, aortic stiffness increased significantly after stent graft deployment with each of the four types of stent graft, with the increase in aortic stiffness depending on the extent of stent graft coverage.
Highlights
Thoracic endovascular aortic repair (TEVAR) is the first choice of treatment for patients with thoracic aortic diseases and suitable anatomy [1]
For the total cohort of 20 aortas, pulse wave velocity (PWV) increased by a mean 0.6 m/s or 8.9% of baseline PWV after deployment of a 100-mm proximal stent graft (P
Univariable regression analysis showed a significant correlation between aortic PWV and extent of stent graft coverage, (P
Summary
Thoracic endovascular aortic repair (TEVAR) is the first choice of treatment for patients with thoracic aortic diseases and suitable anatomy [1]. Understanding the effects of stent graft deployment on aortic physiology may help to explain some of the long-term outcomes after TEVAR. Stent graft deployment has been shown to significantly increase aortic stiffness [2], which has been clearly established as an independent predictor of cardiovascular mortality [3]. It is currently unknown which factors are related to the increase in aortic stiffness after TEVAR. We hypothesized that different stent graft designs may have different stiffening effects. We hypothesized that the length of aorta that is covered by stent graft is related to the increase in aortic stiffness after TEVAR. The aim of this experimental study was to investigate whether the stiffening effects of stent graft deployment are dependent on stent graft type and length
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