P-083 - ASSESSING THE IMPACT OF ENDOVASCULAR AND OPEN AORTIC REPAIR ON AORTIC STIFFNESS, CARDIAC REMODELING, AND AORTIC REMODELING: UPDATE FROM TWO SYSTEMATIC REVIEWS

TOPIC:
Other
AUTHORS:
Mandigers T. (Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico ~ Milano ~ Italy) , Bissacco D. (Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico ~ Milano ~ Italy) , Conti M. (Civil Engineering and Architecture Department, Università degli Studi di Pavia ~ Pavia ~ Italy) , Domanin M. (Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico ~ Milano ~ Italy) , Scudeller L. (Department of Clinical Epidemiology and Biostatistics, IRCCS Ca' Granda Ospedale Maggiore Policlinico ~ Milano ~ Italy) , Bianchi D. (Civil Engineering and Architecture Department, Università degli Studi di Pavia ~ Pavia ~ Italy) , Allievi S. (Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico ~ Milano ~ Italy) , D'Alessio I. (Department of Vascular Surgery, Fondazione "De Gasperis" Grande Ospedale Metropolitano Niguarda, Milan, Italy ~ Milano ~ Italy) , Tolva V.S. (Department of Vascular Surgery, Fondazione "De Gasperis" Grande Ospedale Metropolitano Niguarda, Milan, Italy ~ Milano ~ Italy) , Piffaretti G. (Vascular Surgery - Department of Medicine and Surgery, University of Insubria, Varese, Italy ~ Milano ~ Italy) , Van Herwaarden J.A. (Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands ~ Utrecht ~ Netherlands) , Auricchio F. (Civil Engineering and Architecture Department, Università degli Studi di Pavia ~ Pavia ~ Italy) , Trimarchi S. (Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico ~ Milano ~ Italy)
Introduction:
Endovascular aortic repair (e.g., TEVAR, EVAR) is replacing open aortic repair (OSR) as the treatment of choice for aortic disease; however, it has also demonstrated to alter cardiovascular hemodynamics. Our aim was to assess the impact of endovascular and open aortic repair on cardiovascular hemodynamics and consequent cardiovascular risk, highlighting these issues both in the general population and in young patients suffering blunt thoracic aortic injury (BTAI).
Methods:
PubMed, Scopus and Web of Science were systematically searched for eligible studies reporting on modifications in aortic stiffness, blood pressure, cardiac mass, and aortic size (e.g., diameter, length, tortuosity). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. The Newcastle-Ottawa Scale was used to assess the methodological quality of included studies.
Results:
A total of 14 studies addressing the impact of TEVAR, EVAR and OSR on aortic stiffness regardless of the type of aortic disease and 12 studies addressing the impact of TEVAR for BTAI on aortic stiffness, blood pressure, cardiac mass, and aortic size were identified. Severe heterogeneity exists among studies regarding demographics, endograft specifications, reported outcomes, and the evaluation method. Aortic stiffness increased after TEVAR and EVAR, in terms of pulse wave velocity, but not after OSR. In young patients treated with TEVAR for BTAI specifically, included studies highlight increases in pulse wave velocity, post-TEVAR hypertension, left ventricular mass, and left ventricular mass index during follow-up. Moreover, aortic dilatation and remodeling is reported to occur after TEVAR for BTAI. One study reported a 2.4-fold faster ascending aorta diameter growth rate versus matched controls, while others highlighted significant changes in aortic size at different locations along the aorta and endograft.
Conclusion:
These systematic reviews highlight adverse cardiovascular changes after endovascular aortic repair, thereby increasing cardiovascular risk. Such aspects might be of importance in all patients, but particularly in young patients. Endograft development that more closely mimics physiological native aortic properties should be encouraged.
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