Impact of thoracic endovascular aortic repair following blunt traumatic thoracic aortic injury on blood pressure
Guala, Andrea (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Gil-Sala, Daniel (Universitat Autònoma de Barcelona. Departament de Cirurgia)
García Reyes, Marvin Ernesto (Hospital Universitari Vall d'Hebron)
Azancot, María A (Hospital Universitari Vall d'Hebron)
Dux-Santoy, Lydia (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Allegue Allegue, Nicolas (Hospital Universitari Vall d'Hebron)
Teixido-Tura, Gisela (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Goncalves Martins, Gabriela (Hospital Universitari Vall d'Hebron)
Galian-Gay, Laura (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Garrido-Oliver, Juan (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Constenla García, Ivan (Hospital Universitari Vall d'Hebron)
Evangelista Masip, Arturo (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Tello Díaz, Cristina (Hospital Universitari Vall d'Hebron)
Carrasco-Poves, Alejandro (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Morales-Galán, Alberto (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ferreira-Gonzalez, Ignacio (Universitat Autònoma de Barcelona. Departament de Medicina)
Rodríguez Palomares, José Fernando (Universitat Autònoma de Barcelona. Departament de Medicina)
Bellmunt Montoya, Sergi (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Data:	2024
Resum:	Background: Blunt traumatic thoracic aortic injuries (BTAIs) are associated with a high mortality rate. Thoracic endovascular aortic repair (TEVAR) is the most frequently used surgical strategy in patients with BTAI, as it offers good short- and middle-term results. Previous studies have reported an abnormally high prevalence of hypertension (HT) in these patients. This work aimed to describe the long-term prevalence of HT and provide a comprehensive evaluation of the biomechanical, clinical, and functional factors involved in HT development. Methods: Twenty-six patients treated with TEVAR following BTAI with no history of HT at the time of trauma were enrolled. They were matched with 37 healthy volunteers based on age, sex, and body surface area and underwent a comprehensive follow-up study, including cardiovascular magnetic resonance, 24-hour ambulatory blood pressure monitoring, and assessment of carotid-femoral pulse wave velocity (cfPWV, a measure of aortic stiffness) and flow-mediated vasodilation. Results: The mean patient age was 43. 5 ± 12. 9 years, and the majority were male (23 of 26; 88. 5%). At a mean of 120. 2 ± 69. 7 months after intervention, 17 patients (65%) presented with HT, 14 (54%) had abnormal nighttime blood pressure dipping, and 6 (23%) high cfPWV. New-onset HT was related to a more proximal TEVAR landing zone and greater distal oversizing. Abnormal nighttime blood pressure was related to high cfPWV, which in turn was associated with TEVAR length and premature arterial aging. Conclusions: HT frequently occurs otherwise healthy subjects undergoing TEVAR implantation after BTAI. TEVAR stiffness and length, the proximal landing zone, and distal oversizing are potentially modifiable surgical characteristics related to abnormal blood pressure.
Nota:	Altres ajuts: Spanish Society of Cardiology (SEC/FEC-INV-CLI32 20/015 and SEC/FEC-INV-CLI 21/030)
Drets:	Aquest material està protegit per drets d'autor i/o drets afins. Podeu utilitzar aquest material en funció del que permet la legislació de drets d'autor i drets afins d'aplicació al vostre cas. Per a d'altres usos heu d'obtenir permís del(s) titular(s) de drets.
Llengua:	Anglès
Document:	Article ; recerca ; Versió acceptada per publicar
Matèria:	TEVAR ; Aorta ; Hypertension ; Aortic stiffness
Publicat a:	Journal of Thoracic and Cardiovascular Surgery, Vol. 168, Núm. 5 (november 2024) , p. 1428-1437.e3, ISSN 1097-685X

DOI: 10.1016/j.jtcvs.2023.07.018

Disponible a partir de: 2025-11-30 Postprint

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