A stiff plastic tube inserted to repair a bulging aorta may be silently straining the heart years after surgery. Doctors increasingly use stent grafts to fix abdominal aortic aneurysms because patients recover faster than with open surgery. But 5 to 18 percent of these patients later suffer major cardiac events—heart attacks or heart failure—for reasons that are not well understood. The researchers suspect the graft itself is to blame: unlike natural artery tissue, the stiff synthetic material forces the heart to pump against greater resistance, gradually weakening it. The team will track patients receiving either stent grafts or open surgery, measuring aortic stiffness and heart function before, during, and six months after the procedure. They will use echocardiograms, MRI, pulse wave velocity, and pressure-volume loops to capture how the heart adapts—or fails to adapt—to the implant. If the link is confirmed, surgeons could better counsel patients on long-term risks and adjust follow-up care to catch declining heart function early. In the longer term, identifying which stent designs and materials cause the least stiffening could guide the development of grafts that preserve both the repair and the heart.
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The use of endovascular aortic repair (EVAR) to repair abdominal aortic aneurysms (AAA) is increasing because of better short-term outcomes compared with open surgical repair. However, long-term benefits of EVAR are in doubt with 5-18% of patients suffering from major adverse cardiac events during follow-up. Implantation of a stent graft is thought to increase aortic stiffness, which increases afterload. We hypothesise that the increase in aortic stiffness associated with EVAR contributes to an increased risk of major adverse cardiac events. We will recruit patients with AAA being treated with either F/BEVAR or open surgical repair and use multiple modalities to investigate aortic stiffness and cardiac function pre-operatively, intra-operatively and 6 months post-operatively. These investigations will include biochemical markers, an echocardiogram, pulse wave velocity measurement, cardiovascular MRI, and pressure-volume loops, combining to give a detailed assessment of aortic stiffness, cardiac morphology and function. We will compare the results between operative approaches at these time intervals while taking potential confounding factors, such as age, pre-existing comorbidities and smoking status, into account. In the short-term our findings will allow us to better counsel patients on the risks and benefits of aneurysm repair and potentially allow us to refine follow-up pathways, identifying deteriorating cardiac function and optimising treatments before major adverse events occur. In the long-term, identification of the impacts of particular stent designs and materials on aortic stiffness and heart function may guide the development of new stent grafts.
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