Left ventricular remodeling following aortic root and ascending aneurysm repair
ObjectiveAdverse left ventricular remodeling due to a mismatch between stiffness of native aortic tissue and current polyester grafts may be under-recognized. This study was conducted to evaluate the impact of proximal aortic replacement on adverse remodeling of the left ventricle.Materials and meth...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.944786/full |
| _version_ | 1811234509943734272 |
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| author | Ignas B. Houben Ignas B. Houben Angel K. Y. Chu Bo Yang Karen M. Kim Shinichi Fukuhara Joost A. van Herwaarden Frans L. Moll David A. Nordsletten David A. Nordsletten C. Alberto Figueroa C. Alberto Figueroa Nicholas S. Burris Himanshu J. Patel |
| author_facet | Ignas B. Houben Ignas B. Houben Angel K. Y. Chu Bo Yang Karen M. Kim Shinichi Fukuhara Joost A. van Herwaarden Frans L. Moll David A. Nordsletten David A. Nordsletten C. Alberto Figueroa C. Alberto Figueroa Nicholas S. Burris Himanshu J. Patel |
| author_sort | Ignas B. Houben |
| collection | DOAJ |
| description | ObjectiveAdverse left ventricular remodeling due to a mismatch between stiffness of native aortic tissue and current polyester grafts may be under-recognized. This study was conducted to evaluate the impact of proximal aortic replacement on adverse remodeling of the left ventricle.Materials and methodsAll aortic root and ascending aortic aneurysm patients were identified (n = 2,001, 2006–2019). The study cohort consisted of a subset of patients (n = 98) with two or more electrocardiogram (ECG)-gated CT angiograms, but without concomitant aortic valve disease or bicuspid aortic valve, connective tissue disease, acute aortic syndrome or prior history of aortic repair or mitral valve surgery. LV myocardial mass was measured from CT data and indexed to body surface area (LVMI). The study cohort was divided into a surgery group (n = 47) and a control group; optimal medical therapy group (OMT, n = 51).ResultsThe mean age was 60 ± 11 years (80% male). Beta-blocker use was significantly more frequent in the surgery group (89 vs. 57%, p < 0.001), whereas, all other antihypertensive drugs were more frequent in the OMT group. The average follow-up was 9.1 ± 4.0 months for the surgery group and 13.7 ± 6.3 months for the OMT group. Average LVMI at baseline was similar in both groups (p = 0.934). LVMI increased significantly in the surgery group compared to the OMT group (3.7 ± 4.1 vs. 0.6 ± 4.4 g/m2, p = 0.001). Surgery, baseline LVMI, age, and sex were found to be independent predictors of LVMI increased on multivariable analysis.ConclusionProximal aortic repair with stiff polyester grafts was associated with increased LV mass in the first-year post-operative and may promote long-term adverse cardiac remodeling. Further studies should be considered to evaluate the competing effects of aortic aneurysm related mortality against risks of long-term graft induced aortic stiffening and the potential implications on current size thresholds for intervention. |
| first_indexed | 2024-04-12T11:38:27Z |
| format | Article |
| id | doaj.art-46b2d9c47c6f475787ac0780a87cfb68 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-12T11:38:27Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-46b2d9c47c6f475787ac0780a87cfb682022-12-22T03:34:46ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-10-01910.3389/fcvm.2022.944786944786Left ventricular remodeling following aortic root and ascending aneurysm repairIgnas B. Houben0Ignas B. Houben1Angel K. Y. Chu2Bo Yang3Karen M. Kim4Shinichi Fukuhara5Joost A. van Herwaarden6Frans L. Moll7David A. Nordsletten8David A. Nordsletten9C. Alberto Figueroa10C. Alberto Figueroa11Nicholas S. Burris12Himanshu J. Patel13Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United StatesDepartment of Vascular Surgery, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United StatesDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United StatesDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United StatesDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United StatesDepartment of Vascular Surgery, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Vascular Surgery, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United StatesDepartment of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United StatesDepartment of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United StatesDepartment of Vascular Surgery, University of Michigan, Ann Arbor, MI, United StatesDepartment of Radiology, University of Michigan, Ann Arbor, MI, United StatesDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United StatesObjectiveAdverse left ventricular remodeling due to a mismatch between stiffness of native aortic tissue and current polyester grafts may be under-recognized. This study was conducted to evaluate the impact of proximal aortic replacement on adverse remodeling of the left ventricle.Materials and methodsAll aortic root and ascending aortic aneurysm patients were identified (n = 2,001, 2006–2019). The study cohort consisted of a subset of patients (n = 98) with two or more electrocardiogram (ECG)-gated CT angiograms, but without concomitant aortic valve disease or bicuspid aortic valve, connective tissue disease, acute aortic syndrome or prior history of aortic repair or mitral valve surgery. LV myocardial mass was measured from CT data and indexed to body surface area (LVMI). The study cohort was divided into a surgery group (n = 47) and a control group; optimal medical therapy group (OMT, n = 51).ResultsThe mean age was 60 ± 11 years (80% male). Beta-blocker use was significantly more frequent in the surgery group (89 vs. 57%, p < 0.001), whereas, all other antihypertensive drugs were more frequent in the OMT group. The average follow-up was 9.1 ± 4.0 months for the surgery group and 13.7 ± 6.3 months for the OMT group. Average LVMI at baseline was similar in both groups (p = 0.934). LVMI increased significantly in the surgery group compared to the OMT group (3.7 ± 4.1 vs. 0.6 ± 4.4 g/m2, p = 0.001). Surgery, baseline LVMI, age, and sex were found to be independent predictors of LVMI increased on multivariable analysis.ConclusionProximal aortic repair with stiff polyester grafts was associated with increased LV mass in the first-year post-operative and may promote long-term adverse cardiac remodeling. Further studies should be considered to evaluate the competing effects of aortic aneurysm related mortality against risks of long-term graft induced aortic stiffening and the potential implications on current size thresholds for intervention.https://www.frontiersin.org/articles/10.3389/fcvm.2022.944786/fullascending aortaventricular remodelingcomputed tomography angiogram (CTA)aortic repairaortic aneurysm (thoracic) |
| spellingShingle | Ignas B. Houben Ignas B. Houben Angel K. Y. Chu Bo Yang Karen M. Kim Shinichi Fukuhara Joost A. van Herwaarden Frans L. Moll David A. Nordsletten David A. Nordsletten C. Alberto Figueroa C. Alberto Figueroa Nicholas S. Burris Himanshu J. Patel Left ventricular remodeling following aortic root and ascending aneurysm repair Frontiers in Cardiovascular Medicine ascending aorta ventricular remodeling computed tomography angiogram (CTA) aortic repair aortic aneurysm (thoracic) |
| title | Left ventricular remodeling following aortic root and ascending aneurysm repair |
| title_full | Left ventricular remodeling following aortic root and ascending aneurysm repair |
| title_fullStr | Left ventricular remodeling following aortic root and ascending aneurysm repair |
| title_full_unstemmed | Left ventricular remodeling following aortic root and ascending aneurysm repair |
| title_short | Left ventricular remodeling following aortic root and ascending aneurysm repair |
| title_sort | left ventricular remodeling following aortic root and ascending aneurysm repair |
| topic | ascending aorta ventricular remodeling computed tomography angiogram (CTA) aortic repair aortic aneurysm (thoracic) |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.944786/full |
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