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Paolo Stassano
Luigi Di Tommaso
Gabriele Iannelli
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J Thorac Cardiovasc Surg 2007;134:925-931
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Response of plasma matrix metalloproteinases and tissue inhibitor of metalloproteinases to stent-graft surgery for descending thoracic aortic aneurysms

Mario Monaco, MD*, Paolo Stassano, MD, Luigi Di Tommaso, MD, Gabriele Iannelli, MD

Department of Cardiac Surgery, University of Naples "Federico II," Naples, Italy.

Received for publication March 18, 2007; revisions received April 19, 2007; accepted for publication May 11, 2007.

* Address for reprints: Mario Monaco, MD, Via A. Falcone, 258-80127 Naples, Italy. (Email: mario.monaco{at}unina.it).

Objective: The role of matrix metalloproteinases and their tissue endogenous inhibitors has been documented in abdominal aortic aneurysms, but few articles have investigated their role after thoracic aortic aneurysm treatment. Our report investigates matrix metalloproteinases and tissue endogenous inhibitor-1 plasmatic changes in patients who have undergone endovascular aneurysm repair for descending thoracic aortic aneurysms and assesses their clinical significance.

Methods: Thirty-two patients with thoracic aortic aneurysms who underwent endovascular aneurysm repair were compared with 25 healthy volunteers. Plasma matrix metalloproteinase-3/matrix metalloproteinase-9 and tissue endogenous inhibitor-1 values were determined by an enzyme-linked immunosorbent assay method at a predetermined time interval.

Results: The preoperative levels of matrix metalloproteinases in the endovascular aneurysm repair group were 3-fold and 2-fold higher than those in the control group (P < .001 and .02, respectively). Matrix metalloproteinase values normalized after endovascular aneurysm repair, whereas patients experiencing endoleaks had higher matrix metalloproteinase values and matrix metalloproteinase-9/tissue endogenous inhibitor-1 ratio compared with the control group (P = .003, < .001, and = .02, respectively, at 1-month follow-up). These values normalized with the resolution of the endoleak.

Conclusions: Plasma matrix metalloproteinase values are increased in patients with thoracic aortic aneurysms, along with reduced tissue endogenous inhibitor-1 expression. Successful endovascular aneurysm repair results in values normalization, whereas high levels persist in patients with endoleaks. The enzyme-linked immunosorbent assay test is a simple and reliable technique that is useful to assess the efficacy of endovascular aneurysm repair and to detect endoleaks.

Abbreviations and Acronyms AAA = abdominal aortic aneurysm; CT = computed tomography; ECM = extracellular matrix; ELISA = enzyme-linked immunosorbent assay; EVAR = endovascular aneurysm repair; MMP = matrix metalloproteinase; TAA = thoracic aortic aneurysm; TIMP = tissue inhibitor of metalloproteinases






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