Inflammatory response after ExoVasc (R) personalized external aortic root support (PEARS) procedure in patients with Marfan syndrome or non-Marfan genetic aortopathy
Abstrakt
Background: The study aimed to determine the severity of inflammatory response after the personalized external aortic root support (PEARS) procedure in comparison to after the standard prophylactic aortic root surgery (SPARS). Materials and methods: The study was a single-centre, retrospective, based on hospital record analysis of patients who underwent the PEARS procedure (PEARS group) or SPARS (SPARS group) during 1998-2017.
C-reactive protein (CRP), white blood count (WBC), and echocardiography were routinely obtained. Fever was defined as body temperature >= 38 degrees C.
Diagnosis of pericarditis included a minimum of three signs from chest pain, pericardial effusion, ST elevation, elevated CRP, and body temperature. Results: PEARS and SPARS groups consisted of 13 and 14 patients, respectively, scheduled for prophylactic aortic root.
A majority of patients in both groups had Marfan syndrome with causal mutation in the fibrillin 1 (FBN1) gene (62% vs 79%). Patient baseline characteristics were similar in the two groups, except aortic root was significantly larger in the SPARS group than in the PEARS group (60 +/- 12 mm vs 48 +/- 5 mm; p = 0.003).
All surgical procedures were successful and without major complications. The peak values of CRP and WBC were significantly higher in the PEARS group (264.5 +/- 84.4 mg/L vs 184.6 +/- 89.6 mg/L; p = 0.034 and 15.2 +/- 3.8 109/L vs 11.9 +/- 3.3 109/L; p = 0.029).
Early and recurrent fever requiring hospital readmission was significantly more frequent in the PEARS group (77% vs 36%; p = 0.032 and 46% vs 7%; p = 0.020). Early and recurrent pericarditis requiring hospital readmission was also more frequent in the PEARS group (31% vs 0%; p = 0.024 and 31% vs 0%; p = 0.024).
Conclusions: The PEARS procedure is an extremely promising surgical technique, but the postoperative inflammatory response occurs frequently and more severely in comparison to SPARS. Clearly, these findings warrant further investigation.