Alterations in Arterial Stiffness and Cardiac Function Following Complex Endovascular Repair of Pararenal and...

Previous studies have demonstrated significant changes in arterial stiffness and secondary cardiac effects following endovascular repair of infrarenal or thoracic aortic aneurysms. However, data remain scarce regarding the impact of more extended complex fenestrated and branched endovascular aortic repair (F/BEVAR) for pararenal and thoracoabdominal aortic aneurysms. This study aimed to investigate alterations in arterial stiffness and cardiac function following F/BEVAR.

A total of 41 patients undergoing F/BEVAR for pararenal or thoracoabdominal aortic aneurysms were prospectively enrolled. Arterial stiffness was evaluated by measuring the carotid-femoral pulse wave velocity (cfPWV). Cardiac function was assessed by left ventricular global longitudinal strain, left atrial volume index, peak atrial longitudinal strain, left ventricular end-diastolic volume, and N-terminal pro-B-type natriuretic peptide. Measurements were obtained preoperatively and at 1 and 6 months postoperatively.

Arterial stiffness increased significantly postoperatively. CfPWV increased from 10.85 ± 2.27 preoperatively to 15.30 ± 3.70 m/s at 1 month (P < 0.001) and remained elevated at 14.54 ± 3.90 m/s (P = 0.22), at 6 months. Ventriculoarterial coupling increased (cfPWV/global longitudinal strain ratio - 0.60 ± 0.23 to - 0.79 ± 0.29 m/s%; P < 0.001). Left atrial volume index increased (30.4 ± 13.7 to 33.1 ± 13.6 ml/m²; P < 0.001), left ventricular end-diastolic volume increased (74.3 ± 21 to 77.1 ± 20.1 mL; P < 0.001), and peak atrial longitudinal strain decreased (30.1 ± 9.7 to 27 ± 8.8%; P = 0.06) at 1 month. N-terminal pro-B-type natriuretic peptide levels increased transiently (341 ± 204 to 1,266 ± 786 pg/mL; P < 0.01) at 1 month follow-up, but seemed to be improved at the second examination. All cardiac markers were elevated at 1-month follow-up and most of them continued to deteriorate at 6 months. A high percentage of aortic coverage seemed to deteriorate the cfPWV measurements.

Endovascular repair of complex aortic aneurysms with F/BEVAR is associated with a significant increase in arterial stiffness and measurable changes in cardiac function. Further research is necessary to better understand the potential implications of these extensive endovascular procedures for the cardiac function in the long-term. In view of these findings, long-term cardiovascular monitoring should be considered for patients undergoing extensive endovascular aortic repair.