Female Sex is Associated with Adverse Cardiac Remodeling and Increased Antihypertensive Requirements After Thoracic...

Thoracic endovascular aortic repair (TEVAR) has largely replaced open surgical repair (OSR) for many thoracic aortic pathologies due to lower perioperative morbidity and mortality. However, the increased aortic stiffness imparted by stent grafts may have long-term cardiovascular consequences, particularly among women. The purpose of this study is to evaluate sex-specific differences in cardiac remodeling and antihypertensive requirements following TEVAR compared with OSR.

A retrospective review was conducted of 671 adult patients who underwent TEVAR or OSR for thoracic aortic aneurysm or dissection between January 2015 and January 2022. Of these, 101 patients met inclusion criteria, with complete 3-year antihypertensive medication and ≥1-year echocardiographic follow-up data. Primary outcomes included changes in left ventricular ejection fraction (LVEF), left ventricular hypertrophy (LVH), and antihypertensive medication requirements. Multivariable Poisson generalized estimating equation and logistic regression models were used to identify factors associated with medication escalation and cardiac remodeling.

Among female patients, TEVAR was associated with significantly greater antihypertensive medication requirements at 12, 24, and 36 months postoperatively (P < 0.05) compared with OSR. Worsening LVH occurred more frequently after TEVAR (P < 0.05), whereas changes in LVEF, rates of stroke, myocardial infarction, and 1-year mortality were similar between groups. In multivariable analysis, TEVAR independently predicted higher antihypertensive requirements (incidence rate ratio (IRR) 1.48; 95% CI, 1.27-1.73; P < 0.001), while OSR was associated with significantly lower odds of worsening LVH compared with TEVAR (OR 0.11; 95% CI, 0.01-0.63; P = 0.012). No significant differences were observed between TEVAR and OSR among male patients.

Female patients undergoing TEVAR demonstrated greater adverse cardiac remodeling and higher antihypertensive requirements than those undergoing OSR. These findings suggest that sex-related differences in aortic stiffness and device oversizing may contribute to poorer long-term remodeling outcomes in women, underscoring the need for sex-specific endograft sizing and development of more compliant endografts.