Heart Failure Rate After Thoracic Endovascular Aortic Repair (TEVAR)

Area of Science:

• Cardiovascular Surgery
• Medical Devices
• Clinical Outcomes

Background:

• Thoracic endovascular aortic repair (TEVAR) is a minimally invasive treatment for thoracic aortic aneurysms (TAA).
• The impact of TEVAR on thoracic aortic hemodynamics and potential induction of heart failure (HF) remains a concern.
• Alterations in blood flow post-stenting may lead to hypertension and reduced coronary perfusion, potentially causing HF.

Purpose of the Study:

• To investigate the incidence of heart failure (HF) following thoracic endovascular aortic repair (TEVAR).
• To analyze the potential association between TEVAR-induced hemodynamic changes and the development of HF.
• To provide clinical insights into HF as a complication of TEVAR.

Main Methods:

• A systematic literature search was conducted across PubMed, Web of Science, Scopus, and the Cochrane library.
• Eleven studies met the inclusion criteria for a meta-analysis.
• The primary endpoint was the raw incidence of HF within 30 days post-TEVAR.

Main Results:

• The meta-analysis included 30,680 patients, with 684 developing HF within 30 days post-TEVAR (2.23%).
• The pooled incidence rate of HF was 0.03 (95% CI [0.02-0.04]), with significant heterogeneity (I²=99.999%) and publication bias observed.
• HF occurrence may be attributed to increased aortic stiffness and subsequent hemodynamic alterations reducing coronary blood supply.

Conclusions:

• Heart failure is a clinically relevant, though often under-recognized, complication occurring in approximately 3% of patients within 30 days after TEVAR.
• Increased aortic stiffness and altered hemodynamics post-TEVAR may contribute to HF development.
• Early pharmacological intervention and hemodynamic optimization are suggested, alongside careful cardiac monitoring, especially in high-risk patients. Further RCTs are warranted.