Key result
Chronic proximal aortic grafts in Marfan syndrome were associated with decreased ascending aortic strain (B= -7.09, p<0.001) and increased descending aortic strain.
Why the study?
Differential biomechanics between chronically grafted and native aortic regions in Marfan syndrome were unknown.
Does proximal graft replacement surgery alter aortic strain and biomechanics in patients with Marfan syndrome compared to non-surgical management?
Observational (n=46)
Does proximal graft replacement surgery alter aortic strain and biomechanics in patients with Marfan syndrome compared to non-surgical management?
In Marfan syndrome, proximal aortic grafting is associated with decreased strain in the grafted ascending aorta but increased strain in the native descending aorta, highlighting altered biomechanics that may contribute to distal aortic risks.
May warrant enhanced distal aortic surveillance after proximal grafting in Marfan syndrome; leaves open prospective outcome studies.
Background Prosthetic graft replacement of thoracic aortic aneurysms (TAA) yields benefits but risks persist in the native aorta, especially in Marfan syndrome (MFS). Differential biomechanics between chronically grafted and native aortic regions are unknown. Methods Functional cardiac magnetic resonance (cine-CMR) imaging was performed in non-surgical MFS patients (root or ascending diameter≤4.5cm) and patients after (>1 year) proximal grafting. Analyses included mid-ascending and -descending aortic size (diameter, area) and compliance indices, including global circumferential strain (GCS), fractional area change (FAC), stiffness index, and distensibility. Results 46 MFS patients underwent cine-CMR, including 21 with chronic proximal grafts (10.5±7.3 years post-operatively). Patients with and without grafts had similar clinical and hemodynamic characteristics. Grafted and non-grafted ascending aortic size was similar between groups (p=NS), but functional parameters differed as evidenced by decrements in GCS, FAC, stiffness index, and distensibility (all p<0.001), consistent with prosthesis-associated reductions in compliance: Proximal grafts associated with decreased ascending aortic strain (B= −7.09, p<0.001) independent of age and aortic root size. Notably, native descending aortic size was larger in post-operative patients (p<0.01), paralleled by increased GCS (p<0.001) and decreased stiffness (p=0.04). In multivariate analysis, proximal grafts associated with increased descending aortic strain when controlling for ascending aortic area (B=4.19, p<0.001) or root size (B=3.14, p=0.045). Conclusions Marfan syndrome patients with chronic proximal aortic grafts manifest distinct vessel wall biomechanics in grafted and native regions that differ from non-surgical comparators, including decreased strain (a marker of reduced compliance) within grafted territories and increased strain in native aortic regions distal to grafts.
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Park et al. (2022) conducted an observational in Marfan syndrome (n=46). Chronic proximal aortic grafts vs. Non-surgical MFS patients was evaluated on Ascending aortic strain (B= -7.09, p=<0.001). Chronic proximal aortic grafts in Marfan syndrome were associated with decreased ascending aortic strain (B= -7.09, p<0.001) and increased descending aortic strain.
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