Διακρατικό ΠΜΣ Ενδαγγειακές Τεχνικές
Βιβλιοθήκη Επιστημών Υγείας

2017-09-12

2017

Μπουλταδάκης Ευάγγελος

Γεώργιος Γερουλάκος, Καθηγητής, Ιατρική, ΕΚΠΑ
Αχιλλέας Χατζηιωάννου, Καθηγητής, Ιατρική, ΕΚΠΑ
Ιωάννης Κακίσης, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ

Does TEVAR modify the cardiac function and the Aortic stiffness?

Ελληνικά

Επηρεάζουν τα ενδαγγειακά μοσχεύματα στην κατιούσα θωρακική αορτή την καρδιακή λειτουργία και την ελαστικότητα της αορτής;

Introduction: It has been reported that TEVAR affects aortic stiffness which is a factor associated with increased cardiovascular morbidity. The purpose of this report is to review the literature and investigate the effect on TEVAR on the aortic stiffness and the cardiac function.
Methods: Medline was searched for relevant articles. After inclusion and exclusion, 26 relevant articles reporting on aortic stiffening and its effect to cardiovascular system remained, and the effect of TEVAR to this situation, allowing for further study.
Results: The sample size of studies upon this subject is limited and translational studies are missing. However, arterial stiffness has been recognized as a measure of target organ damage and its clinical implications should be considered together with the cardiac function. Increased central aortic stiffness has potentially important prognostic implications and it has been associated with increased cardiovascular morbidity and mortality. Pulse Wave Velocity (PWV) is accepted as the most simple, robust, and reproducible method to determine the regional arterial stiffness. In addition, PWV was a major independent predictor of Cardiovascular (CV) mortality and was extremely powerful over the cut-off point of 17.7 m/sec. The results of the arterial stiffening especially after intervention to the aorta can also be observed in patients with aortic coarctation. In these kind of patients, several studies supported that stent does not alter the overall hemodynamics of the aorta. However, alterations of the normal laminar blood flow at the level of the interface between the stent and the native artery induced oxidative stress (OS), endothelial dysfunction (ED) and increased protein turn over in the ascending aorta (ASAO) above the stent. The conclusion is that having implanted a stent in it of otherwise normal animals, it can induce OS, ED, and increased stiffness in ASAO but not hypertension. The issue of hypertension is controversial because different studies suggest that is a usual result after TEVAR procedures. Finally, it is reported that hemodynamic parameters, including cardiac index and stroke volume, were improved after aortic aneurysm repair with both open and endovascular surgery. The left ventricular ejection fraction improved from 13% pre-surgery to 55% post-surgery and the serum brain natriuretic peptide (BNP) level had significantly decreased to 70 – 240 pg/mL.
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Conclusions: The results of this study show that endovascular techniques have controversial effect to cardiac function. However, it can be concluded that blood pressure is a matter of study because in either elevated (hypertension) or small levels (small diastolic pressure) can affect the coronary arteries. Inn addition, PWV is an important index for the evaluation of patients with TEVAR. Also, a cut off point of of 17.7 m/sec can be used as a major independent predictor of Cardiovascular (CV) mortality. It is obvious that small research has been done to this particular subject.

Επιστήμες Υγείας

TEVAR, Ελαστικότητα αορτής, Καρδιακή λειτουργία, Ανευρύσματα

Όχι

1

Ναι

68

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https://pergamos.lib.uoa.gr/uoa/dl/object/1914774/file.pdf

https://pergamos.lib.uoa.gr/uoa/dl/object/1914774