Geometric, Biomechanic and Haemodynamic Aortic Abnormalities Assessed by 4D Flow Cardiovascular Magnetic Resonance in Patients Treated by TEVAR Following Blunt Traumatic Thoracic Aortic Injury
Gil-Sala, Daniel (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Guala, Andrea (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Garcia Reyes, Marvin (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)
Ruiz Muñoz, Aroa (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)
Ferreira González, Ignacio (Universitat Autònoma de Barcelona. Departament de Medicina)
Rodríguez Palomares, José F (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Bellmunt Montoya, Sergi (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Fecha:	2021
Resumen:	Objective: Thoracic endovascular aortic repair (TEVAR) is widely used for the treatment of patients with blunt traumatic thoracic aortic injury (BTAI). However, aortic haemodynamic and biomechanical implications of this intervention are poorly investigated. This study aimed to assess whether patients treated by TEVAR following BTAI have thoracic aortic abnormalities in geometry, stiffness, and haemodynamics. Methods: Patients with BTAI treated by TEVAR at Vall d'Hebron Hospital between 1999 and 2019 were compared with propensity score matched healthy volunteers (HVs). All subjects underwent cardiovascular magnetic resonance (CMR) comprising a 4D flow CMR sequence. Spatially resolved aortic diameter, length, volume, and curvature were assessed. Pulse wave velocity, distensibility, and longitudinal strain (all measurements of aortic stiffness) were determined regionally. Moreover, advanced haemodynamic descriptors were quantified: systolic flow reversal ratio (SFRR), quantifying backward flow during systole, and in plane rotational flow (IRF), measuring in plane strength of helical flow. Results: Twenty-six BTAI patients treated by TEVAR were included and matched with 26 HVs. They did not differ in terms of age, sex, and body surface area. Patients with TEVAR had a larger and longer ascending aorta (AAo) and marked abnormalities in local curvature. Aortic stiffness was greater in the aortic segments proximal and distal to TEVAR compared with controls. Moreover, TEVAR patients presented strongly altered flow dynamics compared with controls: a reduced IRF from the distal AAo to the proximal descending aorta and an increased SFRR in the whole thoracic aorta. These differences persisted adjusting for cardiovascular risk factors and were independent of time elapsed since TEVAR implantation. Conclusion: At long term follow up, previously healthy patients who underwent TEVAR implantation following BTAI had increased diameter, length and volume of the ascending aorta, and increased aortic stiffness and abnormal flow patterns in the whole thoracic aorta compared with matched controls. Further studies should address whether these alterations have clinical implications.
Ayudas:	Instituto de Salud Carlos III PI17/00381 Instituto de Salud Carlos III PI19/01480 Ministerio de Economía y Competitividad RTC-2016-5152-1 Ministerio de Ciencia e Innovación IJC2018-037349-I
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Lengua:	Anglès
Documento:	Article ; recerca ; Versió acceptada per publicar
Materia:	Thoracic Aorta ; Trauma ; Endovascular procedures ; Aortic stiffness ; Magnètic resonance imaging ; Hemodynamics
Publicado en:	European Journal of Vascular and Endovascular Surgery, Vol. 62, Núm. 5 (November 2021) , p. 797-807, ISSN 1532-2165

DOI: 10.1016/j.ejvs.2021.07.016

Postprint 56 p, 5.3 MB

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