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Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus
BACKGROUND: Post-implantation syndrome (PIS) is defined as non-infectious continuous fever and a concomitant rise in inflammatory markers shortly after endovascular aortic repair. PIS occurrence after hybrid procedures, such as the frozen elephant trunk (FET) technique, has not been adequately inves...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339746/ https://www.ncbi.nlm.nih.gov/pubmed/34422358 http://dx.doi.org/10.21037/jtd-21-398 |
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author | Ibrahim, Abdulhakim Marchiori, Elena Eierhoff, Thorsten Martens, Sven Motekallemi, Arash Rukosujew, Andreas Oberhuber, Alexander Asciutto, Giuseppe |
author_facet | Ibrahim, Abdulhakim Marchiori, Elena Eierhoff, Thorsten Martens, Sven Motekallemi, Arash Rukosujew, Andreas Oberhuber, Alexander Asciutto, Giuseppe |
author_sort | Ibrahim, Abdulhakim |
collection | PubMed |
description | BACKGROUND: Post-implantation syndrome (PIS) is defined as non-infectious continuous fever and a concomitant rise in inflammatory markers shortly after endovascular aortic repair. PIS occurrence after hybrid procedures, such as the frozen elephant trunk (FET) technique, has not been adequately investigated. The current study aims to define the incidence of PIS after the FET and to identify possible risk factors associated with its occurrence. METHODS: The clinical charts of 59 patients undergoing the FET between February 2015 and April 2020 were reviewed retrospectively. The occurrence of PIS was defined as the presence of fever (>38 °C lasting longer than one day during the hospitalisation) and leucocytosis (white blood cell count >12,000/µL). Patients with concomitant conditions possibly leading to fever and/or leucocytosis were excluded. Beside demographic and procedure-related data, serum/plasma inflammatory markers were evaluated before surgery and daily up to seven days postoperatively. Computed tomography scans (CT) were examined to calculate the volume of pre-existent and new-onset mural thrombus after the FET. RESULTS: Thirty-eight patients met the inclusion criteria. The study cohort was divided into two groups based on the occurrence of PIS (17 cases; 44.7%). Patients with PIS were significantly younger than those without PIS (53.5±8.9 vs. 62.5±9.6 years; P=0.005). Female patients were less likely to develop PIS (5.2% vs. 26.3%, P=0.018). Patients with PIS had a higher volume of new-onset thrombus in the postoperative CT (P<0.001). Patients treated for post-dissection aneurysm had, postoperatively, significantly more thrombus material developed in a false lumen (P=0.02). Among the PIS markers, CRP (C-reactive protein) levels on the third postoperative day were independently associated with the volume of new-onset thrombus (P=0.011). After multivariate analysis, the volume of new-onset thrombus (P=0.028) and age (P=0.036) remained the variable associated with a statistically significant increased incidence of PIS. CONCLUSIONS: PIS can occur after the frozen elephant trunk procedure. The volume of new-onset thrombus seems to be associated with an increased incidence of PIS. These findings need to be confirmed in larger patient cohorts. |
format | Online Article Text |
id | pubmed-8339746 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-83397462021-08-20 Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus Ibrahim, Abdulhakim Marchiori, Elena Eierhoff, Thorsten Martens, Sven Motekallemi, Arash Rukosujew, Andreas Oberhuber, Alexander Asciutto, Giuseppe J Thorac Dis Original Article BACKGROUND: Post-implantation syndrome (PIS) is defined as non-infectious continuous fever and a concomitant rise in inflammatory markers shortly after endovascular aortic repair. PIS occurrence after hybrid procedures, such as the frozen elephant trunk (FET) technique, has not been adequately investigated. The current study aims to define the incidence of PIS after the FET and to identify possible risk factors associated with its occurrence. METHODS: The clinical charts of 59 patients undergoing the FET between February 2015 and April 2020 were reviewed retrospectively. The occurrence of PIS was defined as the presence of fever (>38 °C lasting longer than one day during the hospitalisation) and leucocytosis (white blood cell count >12,000/µL). Patients with concomitant conditions possibly leading to fever and/or leucocytosis were excluded. Beside demographic and procedure-related data, serum/plasma inflammatory markers were evaluated before surgery and daily up to seven days postoperatively. Computed tomography scans (CT) were examined to calculate the volume of pre-existent and new-onset mural thrombus after the FET. RESULTS: Thirty-eight patients met the inclusion criteria. The study cohort was divided into two groups based on the occurrence of PIS (17 cases; 44.7%). Patients with PIS were significantly younger than those without PIS (53.5±8.9 vs. 62.5±9.6 years; P=0.005). Female patients were less likely to develop PIS (5.2% vs. 26.3%, P=0.018). Patients with PIS had a higher volume of new-onset thrombus in the postoperative CT (P<0.001). Patients treated for post-dissection aneurysm had, postoperatively, significantly more thrombus material developed in a false lumen (P=0.02). Among the PIS markers, CRP (C-reactive protein) levels on the third postoperative day were independently associated with the volume of new-onset thrombus (P=0.011). After multivariate analysis, the volume of new-onset thrombus (P=0.028) and age (P=0.036) remained the variable associated with a statistically significant increased incidence of PIS. CONCLUSIONS: PIS can occur after the frozen elephant trunk procedure. The volume of new-onset thrombus seems to be associated with an increased incidence of PIS. These findings need to be confirmed in larger patient cohorts. AME Publishing Company 2021-07 /pmc/articles/PMC8339746/ /pubmed/34422358 http://dx.doi.org/10.21037/jtd-21-398 Text en 2021 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Ibrahim, Abdulhakim Marchiori, Elena Eierhoff, Thorsten Martens, Sven Motekallemi, Arash Rukosujew, Andreas Oberhuber, Alexander Asciutto, Giuseppe Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus |
title | Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus |
title_full | Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus |
title_fullStr | Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus |
title_full_unstemmed | Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus |
title_short | Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus |
title_sort | post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339746/ https://www.ncbi.nlm.nih.gov/pubmed/34422358 http://dx.doi.org/10.21037/jtd-21-398 |
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