Daijiro Hori
Nationality
Japan
Current Position
Associate Professor
Organization
Saitama Medical Center, Jichi Medical University
Thoracic Aorta Session

Topic: Changes in pulse wave velocity after aortic aneurysm repair

Abstract

Pulse wave velocity (PWV), which is a measure for aortic stiffness, is a well-known factor associated with cardiovascular event. Previous meta-analysis has shown that a 1 m/s increase in PWV was associated with a 12% increase in the risk of cardiovascular events. Medication to reduce PWV has been suggested, including antihypertensive drugs, statins, peroral antidiabetics, advanced glycation end-products (AGE) cross-link breakers, anti-inflammatory drugs, endothelin-A receptor antagonists, and vasopeptidase inhibitors. By Windkissel effect, the aorta stores 50% of left ventricular volume during systole, which is released at diastole by its elastic force. This phenomenon allows constant flow to the peripheral, which reduces mechanical stress on the aorta. Increase in PWV results in earlier pulse wave return to the aortic root, which results in increased systolic pressure and reduced diastolic pressure causing myocardial ischemia. Further, loss of cushioning effect of the aorta results in increased hemodynmic load to the peripheral , thus causing end-organ damages. With development of endovasulcar technology, more patients with aortic anerusym are treated by stent-grafts. However, replacement of the aorta with aortic prosthesis has been shown to result in increased PWV. Meanwhile, previous study has shown that expanded polytetrafluoroethylene (ePTFE) has less effect on the changes in PWV compared to dacron graft. Computational analysis has also shown that ePTFE was more compliant compared to dacron graft. Several modifications to the stent-graft have been applied to improve its profile and stability during deployment. However, stent-graft design to reduce its effect on PWV has not been establlished. From July 2008 to December 2020, 263 patients underwent endovascular treatment of true thoracic aortic aneurysm in our hospital. Retospective analysis of these patients suggested that specific stent-graft design, adjustemnet of treatment length and peri-operative medication may be a solution to protect patients from increased cardiovascular risk associated with increasd PWV.

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