The Effect of Ascending Aortic Repair on Left Ventricular Remodeling

Published:September 03, 2022DOI:
      Left ventricular (LV) hypertrophy is common in patients with thoracic aortic diseases and is associated with increased long-term mortality. Thoracic aortic aneurysms are reported to increase LV afterload because of kinetic energy loss within the aneurysm sac, which may improve after surgical repair. However, LV afterload may also increase because of the stiffness of prosthetics used for aortic repair. We sought to investigate the long-term effect of surgical aortic repair with prostheses on postsurgical LV mass. We reviewed patients who underwent ascending aortic replacement with a prosthesis at our institution from January 2008 to December 2018. We calculated the LV mass index based on pre- and postoperative echocardiogram measurements. The primary outcome was the change in LV mass index 6 months after aortic repair. Patients aged <18 years and those who had concomitant cardiac operations, severe aortic valve disease, or who had no echocardiographic data were excluded. Of 1,008 patients who underwent ascending aortic replacement, 134 (51 with acute aortic dissections) were included. The median baseline and follow-up LV mass index were 107 (90 to 135) g/m2 and 101 (83 to 123) g/m2, respectively. Overall, there was a significant reduction of LV mass index over time (p = 0.03). LV mass index decreased in 77 patients (59%). Presentation due to acute aortic dissection (p = 0.03) and baseline LV mass index (p <0.001) were significant predictors of LV mass reduction. In conclusion, LV mass index may significantly decrease over time after the aortic repair, but the course is highly variable. The largest decrease occurred in patients who presented because of aortic dissections rather than for elective repair of aneurysms.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Estrera AL
        • Miller 3rd, CC
        • Lee TY
        • Shah P
        • Safi HJ
        Ascending and transverse aortic arch repair: the impact of retrograde cerebral perfusion.
        Circulation. 2008; 118: S160-S166
        • Ikeno Y
        • Yokawa K
        • Koda Y
        • Gotake Y
        • Henmi S
        • Nakai H
        • Yamanaka K
        • Inoue T
        • Tanaka H
        • Okita Y.
        The fate of the downstream aorta after open aortic repair for acute DeBakey type I aortic dissection: total arch replacement with elephant trunk technique versus non-total arch replacement†.
        Eur J Cardiothorac Surg. 2019; 55: 966-974
        • Shenasa M
        • Shenasa H.
        Hypertension, left ventricular hypertrophy, and sudden cardiac death.
        Int J Cardiol. 2017; 237: 60-63
        • Bluemke DA
        • Kronmal RA
        • Lima JA
        • Liu K
        • Olson J
        • Burke GL
        • Folsom AR.
        The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study.
        J Am Coll Cardiol. 2008; 52: 2148-2155
        • Chatterjee S
        • Bavishi C
        • Sardar P
        • Agarwal V
        • Krishnamoorthy P
        • Grodzicki T
        • Messerli FH.
        Meta-analysis of left ventricular hypertrophy and sustained arrhythmias.
        Am J Cardiol. 2014; 114: 1049-1052
        • Taylor AP
        • Freeman RV
        • Bartek MA
        • Shalhub S.
        Left ventricular hypertrophy is a possible biomarker for early mortality after type B aortic dissection.
        J Vasc Surg. 2019; 69: 1710-1718
        • Yildiz M
        • Oktay AA
        • Stewart MH
        • Milani RV
        • Ventura HO
        • Lavie CJ.
        Left ventricular hypertrophy and hypertension.
        Prog Cardiovasc Dis. 2020; 63: 10-21
        • Itatani K
        • Miyazaki S
        • Furusawa T
        • Numata S
        • Yamazaki S
        • Morimoto K
        • Makino R
        • Morichi H
        • Nishino T
        • Yaku H.
        New imaging tools in cardiovascular medicine: computational fluid dynamics and 4D flow MRI.
        Gen Thorac Cardiovasc Surg. 2017; 65: 611-621
        • Sugawara M.
        Blood flow in the heart and large vessels.
        Med Prog Technol. 1987; 12: 65-76
        • Borlaug BA
        • Kass DA.
        Ventricular-vascular interaction in heart failure.
        Heart Fail Clin. 2008; 4: 23-36
        • Kass DA.
        Ventricular arterial stiffening: integrating the pathophysiology.
        Hypertension. 2005; 46: 185-193
        • Roman MJ
        • Ganau A
        • Saba PS
        • Pini R
        • Pickering TG
        • Devereux RB.
        Impact of arterial stiffening on left ventricular structure.
        Hypertension. 2000; 36: 489-494
        • Morita S
        • Asou T
        • Kuboyama I
        • Harasawa Y
        • Sunagawa K
        • Yasui H.
        Inelastic vascular prosthesis for proximal aorta increases pulsatile arterial load and causes left ventricular hypertrophy in dogs.
        J Thorac Cardiovasc Surg. 2002; 124: 768-774
        • Takeda Y
        • Sakata Y
        • Ohtani T
        • Tamaki S
        • Omori Y
        • Tsukamoto Y
        • Aizawa Y
        • Shimamura K
        • Shirakawa Y
        • Kuratani T
        • Sawa Y
        • Yamamoto K
        • Mano T
        • Komuro I.
        Endovascular aortic repair increases vascular stiffness and alters cardiac structure and function.
        Circ J. 2014; 78: 322-328
        • Du Y
        • Aizezi M
        • Lin H
        • Xie X
        • He J
        • Qi B
        • Zhang W
        • Naibi A
        • Guo S
        • Guo Y
        • Liu J
        • Zhang Z
        • Tang H
        • Yang X.
        Left ventricular remodeling in patients with acute type B aortic dissection after thoracic endovascular aortic repair: short- and mid-term outcomes.
        Int J Cardiol. 2019; 274: 283-289
        • Kim SY
        • Hinkamp TJ
        • Jacobs WR
        • Lichtenberg RC
        • Posniak H
        • Pifarré R.
        Effect of an inelastic aortic synthetic vascular graft on exercise hemodynamics.
        Ann Thorac Surg. 1995; 59: 981-989
        • Scharfschwerdt M
        • Sievers HH
        • Greggersen J
        • Hanke T
        • Misfeld M.
        Prosthetic replacement of the ascending aorta increases wall tension in the residual aorta.
        Ann Thorac Surg. 2007; 83: 954-957
        • Dobson G
        • Flewitt J
        • Tyberg JV
        • Moore R
        • Karamanoglu M.
        Endografting of the descending thoracic aorta increases ascending aortic input impedance and attenuates pressure transmission in dogs.
        Eur J Vasc Endovasc Surg. 2006; 32: 129-135
        • Little SH
        • Oh JK
        • Gillam L
        • SenGupta PP
        • Orsinelli DA
        • Cavalcante JL
        • Chang JD
        • Adams DH
        • Zorn GL
        • Pollak AW
        • Abdelmoneim SS
        • Reardon MJ
        • Qiao H
        • Popma JJ.
        Self-expanding transcatheter aortic valve replacement versus surgical valve replacement in patients at high risk for surgery: a study of echocardiographic change and risk prediction.
        Circ Cardiovasc Interv. 2016; 9e003426
        • Tanaka A
        • Estrera AL.
        Simple retrograde cerebral perfusion is as good as complex antegrade cerebral perfusion for hemiarch replacement.
        J Vis Surg. 2018; 4: 50
        • Hastie T
        • Tibshirani R
        • Friedman J.
        The Elements of Statistical Learning: Data Mining, Inference, and Prediction.
        Springer Science & Business Media, New York2009 (:649–498)
        • Sill M
        • Hielscher T
        • Becker N
        • Zucknick M.
        c060: extended inference with lasso and elastic-net regularized Cox and generalized linear models.
        J Stat Softw. 2014; 62: 1-22
        • Friedman J
        • Hastie T
        • Tibshirani R.
        Regularization paths for generalized linear models via coordinate descent.
        J Stat Softw. 2010; 33: 1-22
        • Milnor WR.
        Arterial impedance as ventricular afterload.
        Circ Res. 1975; 36: 565-570
        • Westerhof N
        • Lankhaar JW
        • Westerhof BE.
        The arterial Windkessel.
        Med Biol Eng Comput. 2009; 47: 131-141
        • Bouthier JD
        • De Luca N
        • Safar ME
        • Simon AC.
        Cardiac hypertrophy and arterial distensibility in essential hypertension.
        Am Heart J. 1985; 109: 1345-1352
        • Kelly RP
        • Tunin R
        • DA Kass
        Effect of reduced aortic compliance on cardiac efficiency and contractile function of in situ canine left ventricle.
        Circ Res. 1992; 71: 490-502
        • Iarussi D
        • Caruso A
        • Galderisi M
        • Covino FE
        • Dialetto G
        • Bossone E
        • de Divitiis O
        • Cotrufo M.
        Association of left ventricular hypertrophy and aortic dilation in patients with acute thoracic aortic dissection.
        Angiology. 2001; 52: 447-455
        • Zhang K
        • Chen J
        • Liu Y
        • Wang T
        • Wang L
        • Wang J
        • Huang H.
        Diastolic blood pressure reduction contributes more to the regression of left ventricular hypertrophy: a meta-analysis of randomized controlled trials.
        J Hum Hypertens. 2013; 27: 698-706