Left Ventricular Remodeling After Hybrid Arch Repair With Zone 0 to 5 Thoracic Endovascular Aortic Repair

As the utilization of thoracic endovascular aortic repair for descending thoracic aorta and aortic arch pathologies continues to increase, several reports have demonstrated negative left ventricular remodelling after thoracic endovascular aortic repair. Left ventricular remodelling with greater proximal extension of thoracic endovascular aortic repair to zone 0 is poorly understood. The objective of our single-institution study is to evaluate the impact of hybrid aortic repair with zone 0 to 5 thoracic endovascular aortic repair on long-term outcomes of left ventricular remodelling and graft patency.

Patients undergoing hybrid arch aortic repair with zone 0-5 thoracic endovascular aortic repair from January 2020 to September 2024 were retrospectively reviewed. Left ventricular remodelling, defined as changes in left ventricular size, shape, and function after injury, was assessed via echocardiography preoperatively, at discharge/day 30, 1 year, and 2 years postoperatively. Mean echocardiographic changes were compared using paired t-tests and Wilcoxon tests. Follow-up CT angiographies evaluated aortic dimensions, type 1a endoleaks, and arch vessel graft patency.

Of 60 patients, 45 had complete echocardiographic follow-up data (mean 23.2 months). Postoperatively, there was 1 death (1.7%), 1 reoperation (1.7%), and 4 dialyses (6.7%). Echocardiographic parameters showed no significant changes (P > .05), including left ventricular myocardial index, with mean changes at early postoperative -8.75 g/m2 (-52.48 to 34.98), P = .26 and at late follow-up -11.09 g/m2 (-55.46 to 33.28), P = .14. Long-term CT angiographies follow-up revealed no type 1a endoleaks, graft migration, or arch vessel occlusion. Residual dissection was most common in the brachiocephalic artery (10.0%), stenosis in the left carotid graft (6.7%), and thrombosis in the left subclavian graft (3.3%). Graft angulation or stenosis was observed across all branch vessels but did not impair distal perfusion or cause symptoms.

Negative left ventricular remodelling reported after thoracic endovascular aortic repair in zones 2 to 5 was not observed in our single-institution experience with hybrid aortic repair with zones 0 to 5 thoracic endovascular aortic repair. Preserved left ventricular remodelling and cardiac function were noted at postoperative and early midterm follow-up. Despite isolated instances of graft kinking and stenoses, there were no associated haemodynamic complications.