Echocardiographic Evaluation of Cardiac Remodeling after FET

Abstract

Background

This study aimed to investigate if frozen elephant trunk (FET) implantation leads to negative cardiac remodeling in dissection and non-dissection patients and to determine whether there are differences when FET is implanted as an aortic redo procedure or initially.

Methods

Between March 2013 and April 2022, 148 patients received FET without any concomitant procedures and therefore formed our cohort. One hundred and four were treated for dissecting and 44 for non-dissecting pathologies. Eighty-four received FET initially and 64 as an aortic redo procedure. Data were collected retrospectively using our center's dedicated aortic database as well as transthoracic echocardiographic reports of our cardiologists.

Results

In the first weeks after FET implantation, dissection and non-dissection patients show a significant increase of mild valvular insufficiencies—a significant decrease of ejection fraction is only seen in dissection patients but these changes do not stay significant during later follow-up. Patients who receive FET as an aortic redo procedure tend to have significantly larger left ventricular (LV) end-diastolic diameters and higher LV masses, however, in longitudinal analysis, there were no long-term negative effects in patients who received FET initially or as aortic redo.

Conclusion

In the first 2 years after implantation, FET has no echocardiographically measurable effect regarding negative cardiac remodeling in dissection and non-dissection patients, independent of the fact it is implanted initially or as an aortic redo procedure.

Keywords

cardiac remodeling - frozen elephant trunk - total aortic arch replacement - echocardiographic evaluation

Ethical Approval Statement

IRB approval was obtained on February 4, 2021 (No. 20-1302) by the institutional review board of the University of Freiburg and the need for informed consent was waived due to retrospective analysis.

Publikationsverlauf

Eingereicht: 20. Januar 2024

Angenommen: 20. August 2024

Artikel online veröffentlicht:
19. September 2024

• References

• 1 Belz GG. Elastic properties and Windkessel function of the human aorta. Cardiovasc Drugs Ther 1995; 9 (01) 73-83
• 2 Tsagakis K, Pacini D, Grabenwöger M. et al. Results of frozen elephant trunk from the international E-vita Open registry. Ann Cardiothorac Surg 2020; 9 (03) 178-188
• 3 Leone A, Beckmann E, Martens A. et al. Total aortic arch replacement with frozen elephant trunk technique: results from two European institutes. J Thorac Cardiovasc Surg 2020; 159 (04) 1201-1211
• 4 Berger T, Weiss G, Voetsch A. et al. Multicentre experience with two frozen elephant trunk prostheses in the treatment of acute aortic dissection. Eur J Cardiothorac Surg 2019; 56 (03) 572-578
• 5 Di Bartolomeo R, Murana G, Di Marco L. et al. Is the frozen elephant trunk frozen?. Gen Thorac Cardiovasc Surg 2019; 67 (01) 111-117
• 6 Bustos CA, García-Herrera CM, Celentano DJ. Mechanical characterisation of Dacron graft: experiments and numerical simulation. J Biomech 2016; 49 (01) 13-18
• 7 Amabili M, Balasubramanian P, Ferrari G, Franchini G, Giovanniello F, Tubaldi E. Identification of viscoelastic properties of Dacron aortic grafts subjected to physiological pulsatile flow. J Mech Behav Biomed Mater 2020; 110: 103804
• 8 Kappetein AP, Head SJ, Généreux P. et al; Valve Academic Research Consortium (VARC)-2. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). Eur J Cardiothorac Surg 2012; 42 (05) S45-S60
• 9 Berger T, Kreibich M, Morlock J. et al. True-lumen and false-lumen diameter changes in the downstream aorta after frozen elephant trunk implantation. Eur J Cardiothorac Surg 2018; 54 (02) 375-381
• 10 Czerny M, Rylski B, Kari FA. et al. Technical details making aortic arch replacement a safe procedure using the Thoraflex™ Hybrid prosthesis. Eur J Cardiothorac Surg 2017; 51 (Suppl. 01) i15-i19
• 11 Kreibich M, Berger T, Morlock J. et al. The frozen elephant trunk technique for the treatment of acute complicated Type B aortic dissection. Eur J Cardiothorac Surg 2018; 53 (03) 525-530
• 12 Berger T, Kreibich M, Rylski B. et al. Evaluation of myocardial injury, the need for vasopressors and inotropic support in beating-heart aortic arch surgery. J Cardiovasc Surg (Torino) 2020; 61 (04) 505-511
• 13 Martens A, Beckmann E, Kaufeld T. et al. Total aortic arch repair: risk factor analysis and follow-up in 199 patients. Eur J Cardiothorac Surg 2016; 50 (05) 940-948
• 14 Di Eusanio M, Pantaleo A, Murana G. et al. Frozen elephant trunk surgery-the Bologna's experience. Ann Cardiothorac Surg 2013; 2 (05) 597-605
• 15 Leontyev S, Misfeld M, Daviewala P. et al. Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques-a single center study. Ann Cardiothorac Surg 2013; 2 (05) 606-611
• 16 Boutouyrie P, Chowienczyk P, Humphrey JD, Mitchell GF. Arterial stiffness and cardiovascular risk in hypertension. Circ Res 2021; 128 (07) 864-886
• 17 Lyle AN, Raaz U. Killing me unsoftly: causes and mechanisms of arterial stiffness. Arterioscler Thromb Vasc Biol 2017; 37 (02) e1-e11
• 18 Gavish B, Izzo Jr JLJ. Arterial stiffness: going a step beyond. Am J Hypertens 2016; 29 (11) 1223-1233
• 19 Spronck B, Heusinkveld MHG, Vanmolkot FH. et al. Pressure-dependence of arterial stiffness: potential clinical implications. J Hypertens 2015; 33 (02) 330-338
• 20 Kreibich M, Morlock J, Beyersdorf F. et al. Decreased biventricular function following thoracic endovascular aortic repair. Interact Cardiovasc Thorac Surg 2020; 30 (04) 600-604
• 21 van Bakel TMJ, Arthurs CJ, Nauta FJH. et al. Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms. Eur J Cardiothorac Surg 2019; 55 (06) 1061-1070
• 22 Hori D, Kusadokoro S, Mieno MN. et al. The effect of aortic arch replacement on pulse wave velocity after surgery. Interact Cardiovasc Thorac Surg 2022; 34 (04) 652-659
• 23 Stratos C, Stefanadis C, Kallikazaros I, Boudoulas H, Toutouzas P. Ascending aorta distensibility abnormalities in hypertensive patients and response to nifedipine administration. Am J Med 1992; 93 (05) 505-512
• 24 Stefanadis C, Dernellis J, Vlachopoulos C. et al. Aortic function in arterial hypertension determined by pressure-diameter relation: effects of diltiazem. Circulation 1997; 96 (06) 1853-1858
• 25 Honda T, Hamada M, Shigematsu Y, Matsumoto Y, Matsuoka H, Hiwada K. Effect of antihypertensive therapy on aortic distensibility in patients with essential hypertension: comparison with trichlormethiazide, nicardipine and alacepril. Cardiovasc Drugs Ther 1999; 13 (04) 339-346
• 26 Mika M, Kanzaki H, Hasegawa T. et al. Arterial stiffening is a crucial factor for left ventricular diastolic dysfunction in a community-based normotensive population. Int J Cardiol Hypertens 2020; 6: 100038
• 27 Abhayaratna WP, Srikusalanukul W, Budge MM. Aortic stiffness for the detection of preclinical left ventricular diastolic dysfunction: pulse wave velocity versus pulse pressure. J Hypertens 2008; 26 (04) 758-764
• 28 Bissacco D, Conti M, Domanin M. et al. Modifications in aortic stiffness after endovascular or open aortic repair: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2022; 63 (04) 567-577