Abstract 12262: Prosthetic Aortic Graft Replacement of the Ascending Thoracic Aorta Augments Distensibility of the Native Descending Aorta Assessed Via Circumferential Vessel Wall Strain

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A12262
• Main Authors: Palumbo, Maria Chiara, Rong, Lisa, Navid, Pedram, Emaminia, Abbas, Kim, Jiwon, Wang, Yadong, Redaelli, Alberto, Roman, Mary J, Devereux, Richard B, Girardi, Leonard N, Gaudino, Mario, Weinsaft, Jonathan W
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19.11.2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.12262

IntroductionIn patients with ascending aortic aneurysms (AA), prosthetic graft replacement yields benefit, but risk for complications in the descending aorta persists. Impact of AA grafts on native descending aortic physiology is poorly understood.MethodsTransthoracic echocardiograms (echo) in pts undergoing AA grafting were analyzedDescending aortic deformation indices included global circumferential strain (GCS), time to peak (TTP) strain, and fractional area change (FAC); pulse Doppler assessed distal aortic flow. Pre and post-surgical echoes were analyzed independently; pts with dissection, severe aortic regurgitation (AR) or stenosis were excluded.Results42 pts (53±19 years, 62% male) undergoing AA grafting were studied; 62% had genetically-mediated AA (31% bicuspid valve∣ 31% Marfan/vascular)After grafting (6.9±7.7 months), native descending aortic distensibility increased based on absolute and pulse pressure corrected strain, as well as FAC (all p<0.001; Table)Increased descending aortic distensibility paralleled altered kinetics, as evidenced by decreased absolute (p=0.007) and heart rate adjusted time to peak strain (p=0.01) and increased peak flow velocity (0.83±0.31 to 0.94±0.32 m/s, p=0.04)Augmented distensibility and flow velocity occurred despite similar pre- and post-graft blood pressure and medications (all p=NS), and was independent of pre-surgical AR or change in LV stroke volume (both p=NS). Despite similar differences when stratified by age, gender, and pre surgical AA size (all p=NS), augmented GCS was greater among pts with Marfan/vascular (Δ = 4.7 ± 3.8) or bicuspid valve (4.1 ± 4.1) vs. degenerative AA (0.8 ± 3.7; p=0.005).ConclusionsProsthetic graft replacement of the ascending aorta increases magnitude and rapidity of distal aortic strain. Graft effects are greatest with genetic AA, providing a potential mechanism for increased energy transmission and post-surgical adverse aortic remodeling.