Heart Failure Rate After Thoracic Endovascular Aortic Repair (TEVAR)

Abstract

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive technique for the treatment of thoracic aortic aneurysms (TAA). We hypothesized that alteration of blood hemodynamics in the thoracic aorta caused by stent implantation can possibly lead to hypertension and reduced coronary flow leading to the induction of heart failure (HF). The search in PubMed, Web of Science, Scopus, and the Cochrane library for studies containing data about the occurrence of HF after TEVAR resulted in 1231 articles of which 11 fulfilled the inclusion criteria. A meta-analysis was undertaken with the raw incidence of HF post-implantation as the primary endpoint. This occurred, in the first 30 days, to 684 out of 30,680 total patients (2.23%), and the raw incidence rate of HF was 0.03 [0.02–0.04], p<0.001. The random effects model was used because the examined studies had significant heterogeneity (I²=99.999%, τ²=3.905×10⁻⁴, p<0.001. In addition, significant publication bias was observed (Egger’s test z=2.156, p=0.031). HF may develop in 30 days post-TEVAR possibly because of the increased aortic stiffness and the subsequent heamodynamic alterations which reduce the coronary blood supply. Thus, it may be necessary to initiate early pharmacological intervention while further research with randomized controlled trials with longer follow-up is warranted for the evaluation of the incidence of HF in the long term after TEVAR.

Clinical Impact

Our meta-analysis shows that heart failure (HF) can occur in approximately 3% of patients within 30 days after TEVAR, indicating that HF is a clinically relevant but often under-recognized complication. Increased aortic stiffness and subsequent heamodynamic alterations which reduce the coronary blood supply may contribute to the development of HF. Our findings highlight the need for careful peri- and post-operative cardiac monitoring, particularly in patients with pre-existing cardiovascular risk and the need for hemodynamic optimization after stent-graft implantation.