Fever Management after TEVAR in Patients with Aortic Dissection

Abstract

Background Post-implantation syndrome (PIS) is characterised as a noninfectious continuous fever and a concomitant rise in inflammatory markers shortly after thoracic endovascular aortic repair (TEVAR). This current study aims to analyse the risk factors of PIS, postoperative major adverse cardiac events (MACE), and overall survival as well as the correlation between new-onset mural thrombus and the risk of developing PIS after TEVAR in patients with type B aortic dissection (TBAD). Patients were included who had a B dissection, both acute and chronic forms. In the acute form, both acutely complicated and uncomplicated patients were included in the study. A main point of our investigation is the postoperative fever management of PIS patients.

Methods A total of 90 patients with type B dissection underwent TEVAR in the University Hospital of Muenster between 2016 and 2020. The occurrence of PIS was defined as the presence of fever (> 38°C lasting longer than 24 hours in hospital) and leucocytosis (white blood cell count > 12000/µL). Patients with other possible reasons for fever and/or leucocytosis, such as a urinary tract infection (UTI), pneumonia, or sepsis, were excluded beforehand. Besides demographic and operation-related data, inflammatory markers and therapeutic measures were evaluated before and 5 days postoperatively. Computed tomography scans were examined to calculate the volume of preexistent and new-onset mural thrombus after TEVAR.

Results Of 90 patients, 40 patients were excluded because of recent infection or bypass surgery. Of the 50 patients included in the study, 10 patients developed post-implantation syndrome. Younger patients significantly more often developed PIS after TEVAR (52.2 ± 11.6 vs. 61.5 ± 13.6, p = 0.045). New-onset thrombus after TEVAR was significantly higher in PIS patients (61 cm³ vs. 12 cm³, p < 0.001) and PIS patients often received more medical examinations (investigation of X-ray, U status, and blood cultures). There was no significant difference in overall survival for 40 months and in the incidence of MACE.

Conclusions PIS may be related to an increased rate of new-onset thrombus. A more robust conclusion is not justified according to our study. There is no difference in overall survival.

Zusammenfassung

Hintergrund Das Postimplantationssyndrom (PIS) ist gekennzeichnet durch nicht-infektiöses anhaltendes Fieber und einen gleichzeitigen Anstieg von Entzündungsmarkern kurz nach einer endovaskulären Aortenreparatur (TEVAR). Ziel dieser Studie ist es, die Risikofaktoren für ein PIS, postoperativ schwerwiegende kardiale Ereignisse und das Gesamtüberleben sowie die Korrelation zwischen neu auftretenden Wandthromben und dem Risiko, nach TEVAR ein PIS zu entwickeln, bei Patienten mit Aortendissektion Typ B zu analysieren. Dabei wurden Patienten eingeschlossen, die eine B-Dissektion, sowohl akute als auch chronische Formen, aufwiesen. Bei der akuten Form wurden sowohl acute-complicated als auch uncomplicated Patienten mit in die Studie eingeschlossen. Ein wichtiger Punkt unserer Untersuchung ist hierbei das postoperative Fiebermanagement von PIS-Patienten.

Methoden Insgesamt 90 Patienten mit Typ-B-Dissektion unterzogen sich zwischen 2016 und 2020 in der Universitätsklinik Münster einer TEVAR. Das Auftreten von PIS wurde definiert als das Vorhandensein von Fieber (> 38 °C, länger als 24 Stunden im Krankenhaus) und Leukozytose (Anzahl der weißen Blutkörperchen > 12000/µl). Patienten mit anderen möglichen Ursachen für Fieber und/oder Leukozytose wie Harnwegsinfektion (HWI), Lungenentzündung oder Sepsis wurden von vornherein ausgeschlossen. Neben demografischen und operationsbezogenen Daten wurden Entzündungsmarker und therapeutische Maßnahmen vor und fünf Tage postoperativ ausgewertet. Computertomografische Aufnahmen wurden zur Berechnung des Volumens von präexistenten und neu aufgetretenen Wandthromben nach TEVAR herangezogen.

Ergebnisse Von 90 Patienten wurden 40 Patienten aufgrund einer kürzlich erfolgten Infektion oder Bypass-Operation ausgeschlossen. Von den 50 in die Studie aufgenommenen Patienten entwickelten 10 Patienten ein Postimplantationssyndrom. Jüngere Patienten hatten signifikant häufiger ein PIS nach TEVAR (52,2 ± 11,6 vs. 61,5 ± 13,6, p = 0,045). Ein neu aufgetretener Thrombus nach TEVAR war bei PIS-Patienten signifikant größer (61 cm³ vs. 12 cm³, p < 0,001) und PIS-Patienten sind behandlungsintensiver und erfordern mehr Untersuchungen (Röntgenuntersuchung, U-Status und Blutkulturen). Es gab keinen signifikanten Unterschied in der Gesamtüberlebenszeit von 40 Monaten postoperativ und in der Häufigkeit von schwerern kardialen Ereignissen.

Schlussfolgerungen Das Neuauftreten von Thromben ist bei PIS-Patienten nach TEVAR erhöht. Es gibt keinen Unterschied im Gesamtüberleben und schwerer kardialer Ereignisse nach nach TEVAR zwischen beiden Gruppen.

Keywords

thrombus - thrombus volume - TEVAR - postimplantation syndrome - fever management - PIS

Schlüsselwörter

Aortendissektion - Postimplantationssyndrom - Typ-B-Dissektion - Fiebermanagement - Thrombusvolumen - TEVAR-Operation

Publication History

Received: 14 February 2022

Accepted after revision: 02 June 2022

Article published online:
01 August 2022

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