Left ventricular remodeling in patients with acute type B aortic dissection after thoracic endovascular aortic repair: Short- and mid-term outcomes

Int J Cardiol. 2019 Jan 1:274:283-289. doi: 10.1016/j.ijcard.2018.09.008. Epub 2018 Sep 7.

Abstract

Background: Left ventricular (LV) remodeling remains unknown in patients with acute Type B aortic dissection (aTBAD) after thoracic endovascular aortic repair (TEVAR) during follow-up.

Methods: Between May 2004 and January 2016, 163 consecutive patients (136 males, mean preoperative age: 51.06 ± 10.79 years) with aTBAD underwent TEVAR. A linear mixed model was used to evaluate risk factor influencing on LV remodeling and investigate longitudinal changes in LV thickness, diameter, volume, function and mass at preoperation, postoperation, short- and mid-term follow-up.

Results: Median follow-up time was 48.0 months (quartiles 1-3, 31-84 months, maximum 147 months). LV thickness and mass followed a continuous downward trend over time. Interventricular septal thickness at end-diastole significantly decreased at mid-term follow-up (time, p < 0.001: preoperative 11.59 ± 0.14 mm vs mid-term 10.82 ± 0.15 mm, p < 0.001; postoperative 11.40 ± 0.14 mm vs mid-term 10.82 ± 0.15 mm, p = 0.006). LV posterior wall thickness at end-diastole was markedly reduced at mid-term follow-up (time, p < 0.001: preoperative 10.89 ± 0.11 mm vs mid-term 10.02 ± 0.11 mm, p < 0.001; postoperative 10.78 ± 0.13 mm vs mid-term 10.02 ± 0.11 mm, p < 0.001; short-term 10.56 ± 0.15 mm vs mid-term 10.02 ± 0.11 mm, p = 0.021). LV mass index markedly decreased during follow-up (time, p = 0.001: preoperative 129.60 ± 3.55 g/m2 vs short-term 119.26 ± 3.19 g/m2, p = 0.009; preoperative 129.60 ± 3.55 g/m2 vs mid-term 115.79 ± 3.62 g/m2, p = 0.003). LV function was improved, but not significantly so, during follow-up. Strict blood pressure control had no influence on LV remodeling. True lumen followed a continuous enlargement trend in terms of proximal thoracic aorta and celiac trunk level during follow-up.

Conclusions: TEVAR can reverse LV remodeling and LV hypertrophy in patients with aTBAD during follow-up.

Keywords: Aortic dissection; Aortic remodeling; Thoracic endovascular aortic repair; Ventricular remodeling.

MeSH terms

  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / surgery*
  • Aortic Aneurysm, Thoracic / complications
  • Aortic Aneurysm, Thoracic / diagnosis
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Dissection / complications
  • Aortic Dissection / physiopathology
  • Aortic Dissection / surgery*
  • Computed Tomography Angiography
  • Echocardiography
  • Endovascular Procedures / methods*
  • Female
  • Follow-Up Studies
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology*
  • Humans
  • Hypertrophy, Left Ventricular / diagnosis
  • Hypertrophy, Left Ventricular / etiology
  • Hypertrophy, Left Ventricular / physiopathology*
  • Male
  • Middle Aged
  • Postoperative Period
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Ventricular Remodeling / physiology*