Predictors and Outcomes of Cardiac Events following Thoracic Endovascular Aortic Repair in Descending Thoracic Aortic Aneurysm and Dissection.

Abstract

Background Cardiac events following thoracic endovascular aortic repair (TEVAR) have been associated with significant morbidity and mortality. However, predictors of post-TEVAR cardiac events in descending thoracic aortic aneurysm or dissection are poorly understood. Methods A retrospective analysis of completed TEVAR procedures performed from 2010 to 2016 was conducted using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) participant user file database. Adult patients (≥18 years) who underwent TEVAR for descending thoracic aortic aneurysm or dissection were identified and 30-day outcomes were examined. An initial univariate analysis was performed to determine associations between all patient variables and cardiac events, defined as myocardial infarction or cardiac arrest that occurred ≤30 days of surgery. Multivariate logistic regression was subsequently performed to identify independent risk factors for cardiac events following TEVAR. Results The study identified 150 out of 2,905 (5.2%) patients who underwent TEVAR for descending thoracic aortic aneurysm or dissection who developed cardiac events. No significant difference in incidence of cardiac events was noted among patients presenting with aortic aneurysm or dissection ( p = 0.339). The overall 30-day mortality rate for all patients was 9.1%. Independent preoperative predictors of post-TEVAR cardiac events included emergency procedure (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.9–4.1, p < 0.01); American Society of Anesthesiologists score >3 (OR 1.71, 95% CI 1.1–2.6, p = 0.01), ventilator dependence (OR 2.33, 95% CI 1.3–4.2, p < 0.01), renal failure (OR 2.53, 95% CI 1.50–4.3, p < 0.01), blood transfusion (OR 1.84, 95% CI 1.1–3.2, p = 0.03), and preoperative leukocytosis (OR 2.45, 1.6–3.8, p < 0.01). After TEVAR, unplanned reintubation (OR 5.52, 95% CI 3.5–8.8, p < 0.01), prolonged mechanical ventilation (OR 1.94, 95% CI 1.2–3.2, p = 0.011), and postoperative blood transfusion (OR 4.02, 95% CI 2.70–6.0, p < 0.01) were independent predictors of cardiac events. Cardiac events greatly increased mortality (60.7 vs. 5.5%), total length of hospital stay (13.2 ± 14.7 days vs. 8.3 ± 9.3 days), and readmission rates (19.3 vs. 8.2%, p < 0.01). Conclusions Cardiac events following TEVAR are associated with significant mortality. Patients with these risk factors should be appropriately monitored to improve outcomes.