Cardiac remodeling and antihypertensive medication changes after thoracic endovascular aortic repair vs open surgical repair

Objective: Cardiovascular complications remain one of the major all-cause mortalities among patients who receive either thoracic endovascular aortic repair (TEVAR) or open surgical repair (OSR). Increased aortic stiffness after endograft deployment has been shown to induce left ventricular hypertrophy, diastolic dysfunction, and reduced coronary flow reserve. However, there is limited data on the hemodynamic effects after OSR. The purpose of this study is to compare the cardiovascular and hemodynamic changes after TEVAR and OSR.

Methods: A retrospective analysis of 100 patients with thoracic aortic aneurysm or dissection who underwent open (n = 50) or endovascular repair (n = 50) was conducted. Information on demographics, medical and surgical history, and clinical outcomes were retrieved. Transthoracic echocardiographic imaging results were collected to assess cardiac function. Changes to antihypertensive medication dosage and number were used as surrogate markers for hemodynamic changes and aortic stiffness.

Results: No statistically significant differences were observed in antihypertensive medication number or dosage between the TEVAR and OSR group at 12 months, 24 months, and 36 months post-surgery. When adjusting for patient demographic factors of age, sex, and body surface area in a multivariable generalized estimating equation model, patients who underwent TEVAR had a higher likelihood of receiving more antihypertensive medications (incidence rate ratio [IRR], 1.131; P = .044). Patient characteristics such as body surface area (IRR, 1.266; P = .001), hypertension (IRR, 2.070; P ≤ .001), diabetes mellitus (IRR, 1.474; P ≤ .001), and end-stage renal disease (IRR, 1.304; P = .011) were also associated with a higher number of antihypertensive medications. A significant increase in beta-blockers (P ≤ .001) and diuretics (P = .046) intake was observed post-TEVAR and post-OSR. No significant differences in left ventricular ejection fraction and left ventricular hypertrophy were observed between the two groups.

Conclusions: We observed a greater likelihood of antihypertensive medications escalation following TEVAR, suggesting an increase in aortic stiffness postoperatively. No significant differences in cardiac remodeling were observed between the two groups. Our findings emphasize the need for an improved postoperative cardiac surveillance program in patients undergoing both TEVAR and OSR. Furthermore, additional innovation is needed to create aortic grafts that are more compatible with the native aorta to reduce long-term cardiovascular complications.