• Andrea Guala, Daniel Gil-Sala, Marvin E Garcia Reyes, Maria A Azancot, Lydia Dux-Santoy, Nicolas Allegue Allegue, Gisela Teixido-Turà, Gabriela Goncalves Martins, Laura Galian-Gay, Juan Garrido-Oliver, Ivan Constenla García, Arturo Evangelista, Cristina Tello Díaz, Alejandro Carrasco-Poves, Alberto Morales-Galán, Ignacio Ferreira-González, Jose Rodríguez-Palomares, and Sergi Bellmunt Montoya.
• Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: andrea.guala@vhir.org.
• J. Thorac. Cardiovasc. Surg. 2023 Jul 23.

BackgroundBlunt 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.MethodsTwenty-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.ResultsThe 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.ConclusionsHT 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.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

4 keywords...

hide…