Abstract
Despite the expanded application of thoracic endovascular aortic repair (TEVAR) in patients with significant cardiac comorbidities, the effect of decreased left ventricular ejection fraction (EF) on outcomes remains unknown. The aim of this study was to compare outcomes in patients with normal and abnormal EFs undergoing TEVAR for type B aortic dissection (TBAD). The Vascular Quality Initiative database was reviewed from 2012-2020. Patients were categorized into severely reduced (EF≤30%), reduced (EF 30-50%) and normal EF (EF>50%). Baseline characteristics, procedural details and 18-month outcomes were compared. Multivariable logistic regression identified factors associated with mortality, major adverse cardiac events (MACE), and aortic-related re-intervention. Of 1,993 patients, 38 (2%) and 208 (10%) patients had SREF and REF. Patients with abnormal EF were more likely to have cardiac comorbidities and be prescribed angiotensin-converting enzyme inhibitors and anticoagulants. Perioperatively, patients with SREF were more likely to experience mortality (13.2% vs 6.7% vs 4.4%, p = .018), MACE (26.3% vs 11.5% vs 8%, p <.001), hemodialysis (13.5% vs 5% vs 2.9%, p = .001) and aortic related reintervention (21.1% vs 13% vs 10%, p= .041), compared to REF and NEF patients. However, these associations were not present on multivariable analysis. At 18 months, mortality was significantly higher in patients with SREF, which was confirmed on multivariable analysis, but depressed EF was not associated with increased aortic reintervention compared to NEF. SREF was not independently associated with peri-operative mortality or MACE compared to NEF. REF had similar risk of morbidity and mortality compared to NEF in both the peri- and early post-operative periods. TEVAR-related complications were similar among the cohorts. As such, TEVAR may be offered to appropriately selected patients regardless of EF.
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