Effect of endoprostheses on pulse wave velocity and its long-term outcomes after thoracic endovascular aortic repair.

Abstract

The purpose of this study was to evaluate the changes in pulse wave velocity and left ventricular dimensions in patients undergoing stent-graft treatment for aortic arch aneurysm. From July 2008 to February 2019, 86 patients underwent thoracic endovascular aortic repair of an aortic arch aneurysm. Changes in pulse wave velocity (PWV), echocardiogram findings, and long-term outcomes were compared between endoskeleton type (n = 60) and exoskeleton type stent-graft (n = 26). There was no significant difference in patient demographics except for diabetes which was more observed in endoskeleton type (p = 0.017). There was a significant increase in PWV in exoskeleton type after surgery, which further progressed at a median follow-up of 32months (before: 2047cm/s vs. after: 2259cm/s vs. follow-up: 2486cm/s, p = 0.010, p = 0.017). No significant difference was observed in endoskeleton type (before: 1980cm/s vs. after: 2058cm/s, vs. follow-up: 2042cm/s, p = 0.25, p = 0.34). Echocardiogram performed at a median period of 46.3months, revealed a significant increase in left ventricular diastolic volume (LVDV) (before: 107.4 ± 20.6ml vs. follow-up: 127.7 ± 27.5ml, p = 0.003) and decrease in e' (before: 5.5 ± 1.78cm/s vs. follow-up: 4.7 ± 1.72cm/s, p = 0.012) in exoskeleton type, while no significant change was observed in endoskeleton type (LVDV: before: 102.6 ± 32.3ml vs. follow-up: 96.9 ± 35.4ml, p = 0.74; e': before: 4.4 ± 1.21cm/s vs. follow-up: 4.8 ± 1.40cm/s, p = 0.68). At the median period of 61.3months, there was no significant difference in long-term mortality (p = 0.89). However, the endoskeleton type was associated with a lower incidence of a cardiac event (p = 0.034) and cerebrovascular event (p = 0.029). Types of endoprosthesis might affect differently on physiological changes and its accommodated risk factors after surgery.