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.
OBJECTIVE
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).


METHODS
This retrospective study included 133 patients with type B AASs undergoing TEVAR; PIS was defined as fever >38°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.


RESULTS
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 µg/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.


CONCLUSIONS
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.
Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany Department of Cardiology, 'Ospedale di Circolo', Varese and University of Insubria, Varese, Italy.
Riccardo
R
Gorla
Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany Institute of Medical Informatics, Biometry, Epidemiology, University Clinic Essen, Germany raimund.erbel@uk-essen.de.
Raimund
R
Erbel
Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany.
Philipp
P
Kahlert
Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany.
Konstantinos
K
Tsagakis
Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany.
Heinz
H
Jakob
Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany.
Amir-Abbas
AA
Mahabadi
Department of Diagnostic and Interventional Radiology and Neuroradiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany.
Thomas
T
Schlosser
University of Michigan, Ann Arbor, MI, USA.
Kim
K
Eagle
'Heart' Department, University Hospital, Salerno, Italy.
Eduardo
E
Bossone
Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany.
Rolf Alexander
RA
Jánosi
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D000818:Animals; D001014:Aortic Aneurysm / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D019616:Thoracic Surgical Procedures / Q000009:adverse effects
D015415:Biomarkers; D015850:Interleukin-6
Acute aortic dissection; Acute aortic syndromes; Intramural haematoma; Penetrating aortic ulcer; Post-implantation syndrome; Thoracic endovascular aortic repair