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

Overview

Journal Aorta (Stamford)

Publisher Thieme

Date 2020 Jun 30

PMID 32599627

Citations 2

Authors

Derrick O Acheampong

Philip Paul

Percy Boateng

I Michael Leitman

Affiliations

Soon will be listed here.

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 ( = 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, < 0.01); American Society of Anesthesiologists score >3 (OR 1.71, 95% CI 1.1-2.6, = 0.01), ventilator dependence (OR 2.33, 95% CI 1.3-4.2, < 0.01), renal failure (OR 2.53, 95% CI 1.50-4.3, < 0.01), blood transfusion (OR 1.84, 95% CI 1.1-3.2, = 0.03), and preoperative leukocytosis (OR 2.45, 1.6-3.8, < 0.01). After TEVAR, unplanned reintubation (OR 5.52, 95% CI 3.5-8.8, < 0.01), prolonged mechanical ventilation (OR 1.94, 95% CI 1.2-3.2, = 0.011), and postoperative blood transfusion (OR 4.02, 95% CI 2.70-6.0, < 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%, < 0.01).

Conclusions: Cardiac events following TEVAR are associated with significant mortality. Patients with these risk factors should be appropriately monitored to improve outcomes.

Citing Articles

Predictors of Lethality, Remodeling, and Aorta-Related Events in Different Types of Proximal Aortic Dissection Surgery.

Sirota D, Zhulkov M, Khvan D, Caus T, Kozlov B, Lukinov V Sovrem Tekhnologii Med. 2023; 15(1):38-50.

PMID: 37388755 PMC: 10306964. DOI: 10.17691/stm2023.15.1.05.

Association of Thoracic Aortic Aneurysm Versus Aortic Dissection on Outcomes After Thoracic Endovascular Aortic Repair.

Hasan I, Brown J, Serna-Gallegos D, Aranda-Michel E, Yousef S, Wang Y J Am Heart Assoc. 2023; 12(6):e027641.

PMID: 36892050 PMC: 10111510. DOI: 10.1161/JAHA.122.027641.

References

Parker J, Golledge J . Outcome of endovascular treatment of acute type B aortic dissection. Ann Thorac Surg. 2008; 86(5):1707-12. DOI: 10.1016/j.athoracsur.2008.06.074. View

Davies J . Endovascular repair of descending thoracic aortic aneurysm: review of literature. Semin Thorac Cardiovasc Surg. 2010; 21(4):341-6. DOI: 10.1053/j.semtcvs.2009.12.002. View

Crawford R, Cambria R, Abularrage C, Conrad M, Lancaster R, Watkins M . Preoperative functional status predicts perioperative outcomes after infrainguinal bypass surgery. J Vasc Surg. 2010; 51(2):351-8. DOI: 10.1016/j.jvs.2009.08.065. View

Ganapathi A, Englum B, Schechter M, Vavalle J, Harrison J, McCann R . Role of cardiac evaluation before thoracic endovascular aortic repair. J Vasc Surg. 2014; 60(5):1196-1203. PMC: 4336174. DOI: 10.1016/j.jvs.2014.05.029. View

Patterson B, Holt P, Nienaber C, Cambria R, Fairman R, Thompson M . Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic Thoracic Endovascular Registry (MOTHER) database. Circulation. 2013; 127(1):24-32. DOI: 10.1161/CIRCULATIONAHA.112.110056. View

Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossetti G . Recommendations for the transfusion of red blood cells. Blood Transfus. 2009; 7(1):49-64. PMC: 2652237. DOI: 10.2450/2008.0020-08. View

Rudarakanchana N, Reeves B, Bicknell C, Heatley F, Cheshire N, Powell J . Treatment decisions for descending thoracic aneurysm: preferences for thoracic endovascular aneurysm repair or surveillance in a discrete choice experiment. Eur J Vasc Endovasc Surg. 2014; 48(1):13-22. DOI: 10.1016/j.ejvs.2014.03.015. View

Shekerdemian L, Bohn D . Cardiovascular effects of mechanical ventilation. Arch Dis Child. 1999; 80(5):475-80. PMC: 1717913. DOI: 10.1136/adc.80.5.475. View

Wiedemann D, Mahr S, Vadehra A, Schoder M, Funovics M, Lowe C . Thoracic endovascular aortic repair in 300 patients: long-term results. Ann Thorac Surg. 2013; 95(5):1577-83. DOI: 10.1016/j.athoracsur.2013.02.043. View

10.

Herzog C . Can we prevent sudden cardiac death in dialysis patients?. Clin J Am Soc Nephrol. 2007; 2(3):410-2. DOI: 10.2215/CJN.01130307. View

11.

Lindner H, Balaban U, Sturm T, Weiss C, Thiel M, Schneider-Lindner V . An Algorithm for Systemic Inflammatory Response Syndrome Criteria-Based Prediction of Sepsis in a Polytrauma Cohort. Crit Care Med. 2016; 44(12):2199-2207. DOI: 10.1097/CCM.0000000000001955. View

12.

Christou N, MORIN J . Host defense mechanisms in elective and emergency vascular surgery: predicting septic-related mortality. J Vasc Surg. 1986; 3(2):338-42. DOI: 10.1067/mva.1986.avs0030338. View

13.

Duke G . Cardiovascular effects of mechanical ventilation. Crit Care Resusc. 2006; 1(4):388-99. View

14.

Goodney P, Travis L, Lucas F, Fillinger M, Goodman D, Cronenwett J . Survival after open versus endovascular thoracic aortic aneurysm repair in an observational study of the Medicare population. Circulation. 2011; 124(24):2661-9. PMC: 3281563. DOI: 10.1161/CIRCULATIONAHA.111.033944. View

15.

Ramachandran S, Nafiu O, Ghaferi A, Tremper K, Shanks A, Kheterpal S . Independent predictors and outcomes of unanticipated early postoperative tracheal intubation after nonemergent, noncardiac surgery. Anesthesiology. 2011; 115(1):44-53. DOI: 10.1097/ALN.0b013e31821cf6de. View

16.

Gupta P, Sundaram A, MacTaggart J, Johanning J, Gupta H, Fang X . Preoperative anemia is an independent predictor of postoperative mortality and adverse cardiac events in elderly patients undergoing elective vascular operations. Ann Surg. 2013; 258(6):1096-102. DOI: 10.1097/SLA.0b013e318288e957. View

17.

Murthy T . Blood transfusion practices in sepsis. Indian J Anaesth. 2014; 58(5):643-6. PMC: 4260313. DOI: 10.4103/0019-5049.144676. View

18.

Alluri R, Leland H, Heckmann N . Surgical research using national databases. Ann Transl Med. 2016; 4(20):393. PMC: 5107400. DOI: 10.21037/atm.2016.10.49. View

19.

Gorla R, Tsagakis K, Horacek M, Mahabadi A, Kahlert P, Jakob H . Impact of Preoperative Anemia and Postoperative Hemoglobin Drop on the Incidence of Acute Kidney Injury and In-Hospital Mortality in Patients With Type B Acute Aortic Syndromes Undergoing Thoracic Endovascular Aortic Repair. Vasc Endovascular Surg. 2017; 51(3):131-138. DOI: 10.1177/1538574417697211. View

20.

Suzuki T, Mehta R, Ince H, Nagai R, Sakomura Y, Weber F . Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003; 108 Suppl 1:II312-7. DOI: 10.1161/01.cir.0000087386.07204.09. View