Clinical features and prognostic value of stent-graft-induced post-implantation syndrome after thoracic endovascular aortic repair in patients with type B acute aortic syndromes

作者：Gorla Riccardo; Erbel Raimund^*; Kahlert Philipp; Tsagakis Konstantinos; Jakob Heinz; Mahabadi Amir Abbas; Schlosser Thomas; Eagle Kim; Bossone Eduardo; Janosi Rolf Alexander

来源：European Journal of Cardio-Thoracic Surgery, 2016, 49(4): 1239-1247.

DOI：10.1093/ejcts/ezv355

• Post-implantation syndrome
• Acute aortic syndromes
• Acute aortic dissection
• Intramural haematoma
• Penetrating aortic ulcer
• Thoracic endovascular aortic repair

The aim of this study was to investigate the incidence, the biomarker profile and the clinical impact of post-implantation syndrome (PIS) after thoracic endovascular aortic repair (TEVAR) for type B acute aortic syndromes (AASs).
This retrospective study included 133 patients with type B AASs undergoing TEVAR; PIS was defined as fever > 38A degrees C, white blood cells (WBCs) > 12.0/nl and C-reactive protein (CRP) > 10 mg/dl within 72 h after TEVAR, despite negative blood cultures. Fibrinogen (FBG), D-dimer (D-d) and interleukin 6 (IL-6) were also determined. The clinical endpoints were all-cause mortality and a composite of major adverse events (MAEs such as aortic rupture, need for reintervention and all-cause mortality) at follow-up.
PIS was diagnosed in 15.8% of patients and was associated with higher peak values of WBC (17.0 +/- 5.1 vs 10.6 +/- 3.7/nl, P = 0.002), CRP (22.0 +/- 5.4 vs 16.8 +/- 8.2 mg/dl, P = 0.03), FBG (779 +/- 246 vs 639 +/- 225 mg/dl, P = 0.046), D-d (1675 +/- 605 vs 1048 +/- 639 A mu g/l, P = 0.003) and IL-6 (192 +/- 101 vs 84 +/- 34 pg/ml, P = 0.03) than non-PIS patients. All-cause mortality did not significantly differ between PIS and non-PIS patients during the index hospitalization (0.0 vs 6.3%; P = 0.60) and at follow-up (18.8 vs 4.9%; P = 0.086). MAEs were more frequent in the PIS than in the non-PIS group (62.5 vs 25.9%; P = 0.004). PIS (hazard ratio [HR] 3.26, P = 0.022), stroke (HR 3.41, P = 0.004), aortic enlargement (HR 6.88, P = 0.001) and partial thrombosis of the false lumen (HR 6.20, P = 0.003) were independent predictors of MAEs.
PIS occurred in 15.8% of patients with AASs without affecting in-hospital outcome. At follow-up, PIS was associated with increased rates of MAEs, but not mortality.

• 出版日期2016-4
• 单位河北医科大学