| Background:The left ventricular(LV)remodeling remains unknown in patients with acute Type B aortic dissection(aTBAD)after thoracic endovascular aortic repair(TEVAR)during follow-up.The aim of this study is to investigate longitudinal changes in left ventricular thickness,diameter,volumes,functions and mass.Methods:Between May 2004 and January 2016,163 consecutive patients(136 males,preoperative age:51.06±10.79 years)with aTBAD survived after TEVAR in People's Hospital of Xinjiang Uygur Autonomous Region.Linear mixed model was used to evaluate risk factor influencing on LV remodeling and to investigate longitudinal changes in left ventricular thickness,diameter,volumes,functions and mass at pre-operation,post-operation,short-term follow-up,mid-term follow-up.Results:Median follow-up time 48.0 months(quartiles1-3,31-84 months,maximum 147months).LV thickness and mass remained a continuous downward trend over time.1)Interventricular septal thickness at end-diastole(IVST)significantly decreased at mid-term follow-up[time,p<0.001:mid-term(10.82±0.15)mm vs pre-operation(11.59±0.14)mm,p<0.001;vs post-operation(11.40±0.14)mm,p=0.006].2)LV posterior wall thickness at end-diastole(PWT)obviously reduced at mid-term follow-up[time,p<0.001:mid-term(10.02±0.11)mm vs pre-operation(10.89±0.11)mm,p<0.001;vs post-operation(10.78±0.13)mm,p<0.001;vs short-term(10.56±0.15)mm,p=0.021].3)LVEDD demonstrated a slightly downward trend at short-term follow-up,and partially returned at mid-term follow-up[time,p=0.419:mid-term(49.19±0.67)mm vs pre-operation(49.47±0.56)mm,p>0.05].4)LVESD sharply shrank at post-operation,with no further significant decrease during follow-up[time,p=0.017:pre-operation(27.41±0.58)mm vs post-operation(26.13 ± 0.55)mm.p=0.045;vs mid-term(26.03±0.67)mm,p>0.05].5)LVEDV gradually shrank over time,but without difference at all time points[time,p=0.421:mid-term(78.18±3.55)ml vs pre-operation(83.30±2.82)ml,p>0.05].6)LVESV marginally shrank at post-operation,then returned at short-term,but noticeably shrank at mid-term[time,p=0.009:mid-term(43.59± 1.44)ml vs pre-operation(48.61 ±1.46)ml,p=0.025].7)LVEF slightly declined at post-operation,but not considerably improved during follow-up[time,p=0.198:mid-term(58.57±0.83)%vs pre-operation(58.01±0.55)%,p>0.05].8)LV mass further markedly decreased during follow-up[time,p=0.001:pre-operation(129.60±3.55)g/m2 vs short-term(119.26±3.19)g/m2,p=0.009;vs mid-term(115.79±3.62)g/m2,p=0.003].9)Strict blood pressure control had no influence on left ventricular remodeling over time.10)True lumen showed a continuous enlargement trend in proximal thoracic aorta level and celiac trunk level during follow-up.Conclusions:TEVAR can reverse LV remodeling and LV hypertrophy in patients with aTBAD.LV remodeling followed aortic remodeling.Background:The influence of aortic root procedures on left ventricular remodeling remains unknown in patients with acute type A aortic dissection(aTAAD).The aim of this study is to evaluate the effects of different aortic root procedures on left ventricular remodeling during early and mid-term follow-up.Methods:Between Dec 2003 and Feb 2016,111 consecutive patients(95 males,preoperative age:47.05±10.61 years)with aTAAD who survived initial surgery treatment in People's Hospital of Xinjiang Uygur Autonomous Region were evaluated.All subjects were divided into two groups based on aortic root procedure type,ascending aorta replacement group(n=63)and aortic root replacement group(n=48).Linear mixed model was used to evaluate risk factor influencing on LV remodeling and to investigate longitudinal changes in left ventricular thickness,diameter,volumes,functions and mass at pre-operation,post-operation,short-term follow-up,mid-term follow-up.Results:Median follow-up of 74.0 months(quartiles1-3,35-106 months,maximum 166 months).1)IVST slightly increased at post-operation,and then continuously decreased during follow-up,but without difference in aortic root replacement group[pre-operation(11.13±0.22)mm vs mid-term(10.93±0.13)mm,p>0.05].In ascending aorta replacement group,IVST showed a slight decrease tendency over time[pre-operation(11.53±0.19)mm vs mid-term(10.93±0.16)mm,p>0.05].2)PWT marginally increased at post-operation,and then continuously declined without significance during follow-up in aortic root replacement group[pre-operation(10.46±0.14)mm vs mid-term(10.41±0.09)mm,p>0.05].PWT presented with similar trend,but remained at a relatively low level in ascending aorta replacement group[pre-operation(10.47±0.18)mm vs mid-term(10.32±0.16)mm,p>0.05].3)LVEDD substantially reduced at post-operation,early and mid-term follow-up,with a slow increase trend since post-operation in aortic root replacement group[pre-operation(55.92±1.34)mm vs post-operation(48.00±0.87)mm,p<0.001;vs early-term(50.26±1.01)mm,p=0.001;vs mid-term(50.08±0.78)mm,p=0.002].A similar trend but relative low level was observed in ascending aorta replacement group[pre-operation(49.89±0.68)mm vs post-operation(47.28±0.72)mm,p=0.011;vs mid-term(49.25±0.0.83)mm;p>0.05].4)LVESD dramatically decreased at post-operation,early and mid-term follow-up,with a marginally increase trend since post-operation in aortic root replacement group[pre-operation(31.88±1.10)mm vs post-operation(27.13±1.04)mm,p<0.001;vs early-term(50.26±1.01)mm,p<0.003;vs mid-term(27.36±0.94)mm,p=0.021].A similar tendency and relative low level was observed in ascending aorta replacement group[pre-operation(27.35±0.54)mm vs post-operation(25.36±0.52)mm,p=0.018;vs mid-term(26.17±0.70)mm,p>0.05].5)LVEDV sharply shrank at post-operation,early-term follow-up,partially returned at mid-term follow-up in aortic root replacement group[pre-operation(111.14±6.95)ml vs post-operation(82.29±4.78)ml,p<0.001;vs early-term(85.15±3.44)ml,p=0.001].In ascending aorta replacement group,LVEDV slightly shrank at post-operation,partially returned during follow-up,but kept at a relatively low level[pre-operation(87.08±3.57)ml vs mid-term(83.34±4.21)ml,p>0.05].6)LVESV considerably shrank at post-operation,early-term follow-up,with a slight increase tendency since post-operation in aortic root replacement group[pre-operation(60.64±3.49)ml vs post-operation(44.40±2.08)ml,p<0.001;vs early-term(47.16±1.79)ml,p=0.001].Ascending aorta replacement group presented a similar trend and relative high level during follow-up in[pre-operation(48.63±2.10)ml vs mid-term(50.43±2.79)ml,p>0.05].7)LVEF mildly declined at post-operation,but not significantly improved during follow-up in aortic root replacement group[pre-operation(55.93±0.80)%vs early-term(57.54±1.06)%,p>0.05;vs mid-term(56.57±1.21)%,p>0.05].A similar trend but with relative high level was observed in ascending aorta replacement group[pre-operation(55.82±0.64)%vs early-term(59.25±0.83)%,p=0.007;vs mid-term(59.46±0.94)%,p=0.015].8)LVMI fluctuated over time toward a noticeable decline at post-operation and mid-term follow-up in aortic root replacement group[pre-operation(146.44±5.43)g/m2 vs post-operation(119.00±3.90)g/m2,p<0.001;vs mid-term(120.21±3.54)g/m2,p=0.001].A similar trend but with relative high level was observed in ascending aorta replacement group[pre-operation(126.31±4.50)g/m2 vs post-operation(117.70±3.99)g/m2,p>0.05;vs mid-term(116.58±3.69)g/m2,p>0.05].9)Aortic root procedure type had impact on LV diameter and volume regression[group-time interaction:p=0.001 for LV end-diastolic diameter(LVEDD);p=0.044 for LV end-systolic diameter(LVESD);p=0.019 for LV end-diastolic volume(LVEDV);p=0.007 for LV end-systolic volume(LVESV)].10)LV diameter,volumes,and mass index maintained with a relative high level during follow-up in subgroup with stent implantation comparision with subgroup without stent implantation.11)True lumen and false lumen demonstrated an expanding tendency in proximal thoracic aorta level and celiac trunk level during follow-up.Conclusions:Aortic root surgery treatment can reverse LV remolding and LVH in patients with aTAAD.Ascending aorta replacement exhibited more preferable LV remodeling than aortic root replacement.Stent implantation can attenuate LV remodeling and LVH reversal.LV remodeling followed aortic remodeling during follow-up. |
PDF Full Text Request