Preoperative exercise tolerance, nutritional-inflammatory markers, and outcomes after TEVAR for type B aortic...

Thoracic endovascular aortic repair (TEVAR) is the cornerstone treatment for type B aortic dissection (TBAD), but delayed discharge and mid-term major adverse events (MAEs) remain important clinical challenges. This single-center retrospective cohort study aimed to explore the associations of preoperative exercise tolerance, nutritional and inflammatory markers with short-term and mid-term outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR) for type B aortic pathology.

A retrospective cohort study enrolled 300 consecutive patients who underwent TEVAR for type B aortic pathology (type B acute aortic syndrome, B-AAS) between 2015 and 2020. The study population included three distinct entities: classic TBAD, intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU), neither of which are regarded as subtypes of aortic dissection. Preoperative exercise tolerance was assessed by 6-minute walking distance (6MWD) and hand grip strength (HGS), together with geriatric nutritional risk index (GNRI), neutrophil-to-lymphocyte ratio (NLR), and activated partial thromboplastin time (APTT). Primary outcomes were delayed discharge and mid-term MAEs. Delayed discharge was explicitly defined as postoperative hospital stay >10 days, and mid-term major adverse events (MAEs) were recorded during follow-up. Univariate and multivariate regression analyses were performed to identify factors independently associated with outcomes, and interaction analyses were further conducted.

Delayed discharge occurred in 18 (6.0%) patients and mid-term MAEs in 38 (12.7%). Independent predictors of delayed discharge included elevated APTT and NLR, and decreased GNRI, 6MWD, and HGS. The nomogram showed good discrimination (AUC: 0.84). Low 6MWD combined with low GNRI or high NLR synergistically increased the risks of delayed discharge and MAEs (both P < 0.001). Restricted cubic spline analyses confirmed linear dose-response relationships.

Preoperative exercise tolerance, nutritional status, and inflammatory biomarkers are independent correlative predictors of short-term and mid-term adverse outcomes after TEVAR. Combined assessment of these simple non-invasive indicators may assist preoperative clinical risk stratification.