Key result
Polyester endografts linked to ~31% increased aortic stiffness one year post-EVAR versus ePTFE.
Why the study?
The effect of different endograft fabrics on aortic stiffness and cardiovascular efficiency after EVAR is not well known.
Does the use of ePTFE versus polyester endografts for EVAR affect aortic stiffness and cardiac function at 1 year in patients with aortic diseases?
Cohort (n=42)
Does the use of ePTFE versus polyester endografts for EVAR affect aortic stiffness and cardiac function at 1 year in patients with aortic diseases?
p-value: p=0.014
Polyester-covered endografts for EVAR are associated with a significant increase in aortic stiffness and arterial elastance at 1 year compared to ePTFE endografts, though both groups show signs of initial diastolic dysfunction.
ePTFE may be preferable to polyester for limiting post-EVAR stiffness; observational data leave open effects on cardiac outcomes.
BACKGROUND: Endovascular aneurysm repair (EVAR) is a safe and durable treatment for aortic diseases but its effect on cardiovascular efficiency it is not well known yet. According to literature, EVAR leads to a worsening of Aortic Stiffness (AoS) with possible cardiac function modifications over time. The aim of the study was to evaluate the possible effect of different endograft fabric on AoS.METHODS: Patients candidate to EVAR were enrolled. Carotid-femoral Pulse Wave Velocity (cf-PWV) and echocardiography data were collected at preoperative time and after one year. Principal data assessed were: cardiac geometry data, arterial elastance (Ea), ventricular elastance (Ees) and their coupling (Ea/Ees), ratio of early ventricular filling to atrial systole (E/A) and ratio of trans-mitral early velocity peak to early diastolic mitral anulus velocity (E/E’). Systolic (SBP) and diastolic blood pressure (DBP) were evaluated. All data were compared between two groups: endograft with expanded polytetrafluoroethylene (ePTFE) and with polyester.RESULTS: Forty-two patients were recruited: fourteen of ePTFE-group and twenty-eight of Polyester-group. Thirty-five patients ended the follow-up. Cf-PWV (13.4±3.7 vs. 17.6±7; P=0.014) and Ea (1.4±0.3 vs. 1.8±0.4; P=0.007) increased significantly only in polyester-group. SBP increased in ePTFE-group (127.9±17 vs. 157.1±20.3; P=0.001) and in Polyester-group (137.9±14.2 vs. 152.4±15.5; P=0.001) and DBP increased in ePTFE-group (68.6±8.4 vs. 77.9±5.8; P=0.004). The E/A ratio decreased significantly in ePTFE-group (0.9±0.3 vs. 0.7±0.2; P=0.031) and in Polyester-group (0.8±0.2 vs. 0.7±0.2; P=0.003). Ventricular elastance grew of 0.3 mmHg/ml/m2 in ePTFE-group. Data regarding cardiac geometry did not change significantly.CONCLUSIONS: Aortic stiffness increases after EVAR, mostly in patients with a polyester-covered device. Both groups show index of possible initial diastolic disfunction. Further investigation is needed to validate our results.
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Mariani et al. (2023) conducted a cohort in Aortic diseases requiring EVAR (n=42). Polyester endograft vs. ePTFE endograft was evaluated on Carotid-femoral Pulse Wave Velocity (cf-PWV) (p=0.014). Polyester-covered endografts were associated with a significant increase in aortic stiffness 1 year after EVAR (cf-PWV 13.4 vs 17.6; P=0.014), unlike ePTFE endografts.
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