Long-term cardiovascular modifications after thoracic endovascular repair for blunt traumatic aortic injury

The aim of this study was to evaluate long-term cardiovascular modifications after thoracic endovascular repair (TEVAR) for blunt traumatic aortic injury (BTAI) based on a single-center, retrospective analysis.

A total of 36 patients underwent TEVAR for BTAI in a single tertiary referral center in the period between January 2008 and September 2024. All patients were recalled and evaluated with clinical examination, arterial pressure and heart rate measurements, pulse wave velocity (PWV) assessment, computed tomography angiography (CTA), and B-mode/2D guided M-mode echocardiography including evaluations of left ventricular mass indexed (LVMi), ejection fraction, and septal thickness. Early (30-day) outcomes were assessed. Estimated 7-year outcomes were evaluated by life-table analysis (Kaplan-Meier Test) in terms of survival, freedom from PWV increase, freedom from new-onset hypertension, freedom from LVMi increase, freedom from ejection fraction <60%, and freedom from septal thickness >11 mm.

Most patients were male (24, 66.7%) with a mean age of 48.9±20.5 years. At postoperative CTA, 3 patients (8.3%) had type Ia endoleak, and underwent reintervention. At 30 days, overall mortality rate was 16.7% (6 cases). The mean follow-up was 90.7±65.1 months. Estimated 7-year overall survival rate of survivors to the first procedure was 92.9%. Estimated 7-year freedom from PWV increase (>10 m/s), freedom from new-onset hypertension, freedom from LVMi increase (>110 g/m²), freedom from ejection fraction <60%, and freedom from septal thickness >11 mm was 85.6%, 80.5%, 85.6%, 75%, and 95.5%, respectively.

In the long-term period TEVAR for BTAI seemed to be associated above all with new-onset hypertension, and an overall reduction of the left ventricular ejection fraction. In addition, arterial stiffness and increase of left ventricular mass are other two key points to be evaluated.