Aortic stenting in the growing sheep causes aortic endothelial dysfunction but not hypertension: Clinical implications for coarctation repair

Maschietto, Nicola; Semplicini, Luca; Ceolotto, Giulio; Cattelan, Anna María; Poser, Helen; Iacopetti, Ilaria; Gerardi, Gabriele; Benedictis, Giulia Maria De; Pilla, Trinadha; Bernardini, Daniele; Aresu, Luca; Rizzo, Stefania; Basso, Cristina; Semplicini, Andrea; Milanesi, Ornella

doi:10.1111/chd.12406

Cited by 4 publications

(2 citation statements)

References 58 publications

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“…In fact, in our cohort CoA-PS patients not only had significant higher age at first repair but also higher BMI values compared to the others, and both factors may contribute to the onset hypertension. In addition, Maschietto et al [1] found in animal models elevated markers of oxidative stress and endothelial damage within the aortic wall proximal to a stent, supposing a higher cardiovascular risk in patients after aortic stenting with premature development of arterial hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Coarctation of the aorta (CoA) is the sixth most common cardiovascular malformation, accounting for 5-8% of all congenital heart diseases, and is mostly diagnosed during infancy [1][2][3]. Since the first surgery performed in 1944 by Crawford [4], surgical repair has been the standard of care for isolated CoA for more than 50 years, via an evolution of approaches following the excision of the aortic coarcted segment, including subclavian flap repair, patch augmentation and, the most common used technique, the end-to-end anastomosis [5].…”

Section: Introductionmentioning

confidence: 99%

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Surgical Versus Percutaneous Stenting Treatment of Isolated Aortic Coarctation: Long-Term Follow-Up

Yammine¹,

Calvieri²,

Chinali³

et al. 2021

Congenital Heart Disease

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Background: In recent decades, aortic stenting has become a promising alternative to surgery for both native aortic coarctation and re-stenosis in children and adults. However, comparative long-term outcomes have poorly been investigated. Methods: We included 212 patients with previous aortic repair (19 ± 8.7 years) divided into 3 groups: 139 with single-time surgical repair (CoA-S group); 18 with single-time percutaneous stenting (CoA-PS group); and 55 hybrid patients with multiple aortic procedures because of re-coarctation occurrence (CoA-H group). All patients underwent 24-hour ambulatory blood pressure monitoring and trans-thoracic echocardiography. Results: After a median follow-up of 17 years after aortic repair, antihypertensive therapy was recorded in a significantly higher proportion of patients (83%) in CoA-PS group compared to 65% and 46% of CoA-H and CoA-S groups, respectively (p = 0.002). Pulse pressure values were higher in CoA-PS patients compared to the others (p < 0.001). Echocardiogram showed significant residual aortic gradient in 50% of CoA-PS and 73% of CoA-H patients compared to 33% of CoA-S patients (p < 0.0001). Indeed, stenting was associated to higher incidence of re-coartaction (p < 0.0001). At multivariate regression Cox analysis adjusted for age at repair and need for antihypertensive therapy, percutaneous stenting was an independent predictor of echocardiographic evidence of re-coarctation (p ≤ 0.001). Conclusion: Aortic coarctation stenting was independently associated with re-coartaction occurrence during long-term follow up when compared to surgical procedures. Furthermore, patients with aortic stenting had lower blood pressure control at 24-hour ambulatory blood pressure monitoring and higher need for antihypertensive therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Versus Percutaneous Stenting Treatment of Isolated Aortic Coarctation: Long-Term Follow-Up

Yammine¹,

Calvieri²,

Chinali³

et al. 2021

Congenital Heart Disease

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Oxidative stress in patients with congenital heart disease: A systematic review

Vanreusel,

Taeymans,

Van Craenenbroeck

et al. 2024

Advances in Redox Research

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Effect of aortic stiffness versus stenosis on ventriculo-arterial interaction in an experimental model of coarctation repair

Panzer

Somer

Segers

et al. 2020

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES The aim of this study was to investigate the effect of short- versus long-segment aortic stiffness and stenosis on ventriculo-arterial interaction in a porcine model of coarctation repair. METHODS Short–long aortic stiffness was created by transection/suture [coarctation (CoA) suture, n = 6] and stenting (stent, n = 5) of the proximal descending aorta. Short–long aortic stenosis was achieved by wrapping a prosthetic graft around the aorta to 1/3-circumference reduction, over a segment length of 1 cm (CoA suture stenosis, n = 5) and 4.5 cm (stent stenosis, n = 6). After 3 months, aortic pressure-flow haemodynamics, aortic distensibility by intravascular ultrasound and left ventricular performance by pressure–volume loops were compared to a Sham group (n = 5) at baseline and during dobutamine administration. RESULTS The aortic impedance increased with 30.3 (12.6%) and 41.3 (20.9%) (P < 0.001) in CoA stenosis and stent stenosis during inotropic response. Impaired haemodynamic aortic compliance was associated with lower aortic distensibility by intravascular ultrasound, specifically in long-segment stenosis. The ventriculo-arterial coupling was disturbed in both groups with stenosis, with blunted contractile response [Sham 140.3 (19.8%), CoA suture 101.3 (14.5%), CoA suture stenosis 75.0 (8.4%), stent 115.5 (12.7%), stent stenosis 55.1 (14.6%), P < 0.001] and increased myocardial stiffness during dobutamine in the long-segment aortic stenosis group [Sham −26.0 (12.9%), CoA suture −27.5 (15.9%), CoA stenosis −9.5 (8.6%), stent −23.4 (4.8%), stent stenosis 19.9 (23.1%), P < 0.001]. CONCLUSIONS This animal study on the sequelae of coarctation repair demonstrated that aortic stiffness had little effect on aortic pressure-flow characteristics in the absence of stenosis. However, the negative chronic effect of stenosis on aortic haemodynamics—especially a longer segment—leads to the rapid impairment of ventriculo-arterial interaction, which is accentuated by inotropy. Therefore, therapeutical management needs to focus on improving aortic remodelling after coarctation repair, preferably by minimizing residual stenosis, even at the cost of inducing aortic stiffness.

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Aortic stenting in the growing sheep causes aortic endothelial dysfunction but not hypertension: Clinical implications for coarctation repair

Abstract: Background: Stent implantation is the treatment of choice for adolescents and adults with aortic

Cited by 4 publications

References 58 publications

Surgical Versus Percutaneous Stenting Treatment of Isolated Aortic Coarctation: Long-Term Follow-Up

Surgical Versus Percutaneous Stenting Treatment of Isolated Aortic Coarctation: Long-Term Follow-Up

Oxidative stress in patients with congenital heart disease: A systematic review

Effect of aortic stiffness versus stenosis on ventriculo-arterial interaction in an experimental model of coarctation repair

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