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The Effect Of Reduced Aortic Compliance After Tevar On Cardiac Remodeling
Christopher M. Faries, MD, Rahman Sayed, MD, Joshua Hsu, MD, Grace Miner, PhD, John Phair, MD, Justin M. George, MD, Ajit Rao, MD, Ageliki G. Vouyuouka, MD, Daniel K. Han, MD, Rami O. Tadros, MD, James F. McKinsey, MD, Michael L. Marin, MD, Peter L. Faries, MD, Christopher J. Smolock, MD.
Icahn School of Medicine at Mount Sinai, new york, NY, USA.
Objectives: Thoracic endovascular aneurysm repair (TEVAR) is the gold standard for management of type B aortic dissections (TBADs) and aneurysms of the thoracic aorta (TAAs) requiring surgical intervention, however these endografts are less compliant than the native aorta. In this study, we investigate the effect of the reduced compliance after endograft deployment on cardiac remodeling using echocardiogram results.
Methods: In this retrospective review of a prospectively maintained database, 482 patients underwent TEVAR for TBAD or TAAs from 2018-2025. Of these patients, 85 (17.6%) had pre- and post-operative echocardiograms. Statistical analysis between groups was done with Student t-tests for continuous variables and a χ2 test for discrete variables.
Results: 56 (65.9%) patients were male, 81 (95.3%) had hypertension, 46 (54.8%) had coronary artery disease, and 18 (21.2%) had congestive heart failure. Mean age was 65.7 +/- 14.3 years. The mean time from preoperative echocardiogram to TEVAR was 236 +/- 443 days, the mean time from TEVAR to postoperative echocardiogram was 552 +/- 531 days. The mean change in ejection fraction after TEVAR was -5.8% +/- 11.4% (p<0.001). 12 (14.2%) patients had new or increased left atrial dilation (p = 0.4), 18 (21.2%) had new or increased left ventricular hypertrophy (p = 0.3), and 48 (56.5%) had new or worsening diastolic dysfunction from preoperative to postoperative echocardiogram (p<0.001). There was no significant difference in change in ejection fraction for patients undergoing TEVAR for repair of an aneurysm compared to repair of a dissection (-6% vs -4.29%, p=0.3).
Conclusions: TEVAR is associated with decreased ejection fraction and increased diastolic dysfunction. This may be related to cardiac remodeling in the setting of reduced compliance of the implanted endograft compared to native aorta. Future development of endografts with increased compliance may mitigate cardiac remodeling after TEVAR.
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