Predictors of one-year major adverse cardiovascular events following elective thoracic endovascular aortic repair: a single-centre retrospective study.

Background: Elective thoracic endovascular aortic repair (TEVAR) is a widely adopted intervention for descending thoracic aortic aneurysms. Over recent years, this endovascular technique has surpassed open surgery due to its reduced complications and mortality rates. However, certain preoperative and periprocedural clinical and analytical factors may significantly impact one-year mortality and the incidence of major adverse cardiovascular events (MACE) in patients. Identifying these predictors is essential for optimizing patient selection and improving postoperative outcomes. This study aims to evaluate the impact of these factors on one-year MACE following elective TEVAR.

Methods: This retrospective, single-centre study included 41 patients with degenerative descending thoracic aneurysm who underwent elective TEVAR between January 2010 and December 2023. Procedures with emergent or urgent indications and patients with a prior history of aortic surgical intervention were excluded. Preoperative variables, including baseline comorbidities, laboratory values, anatomical characteristics, and procedure-specific planning details, were recorded. The primary endpoint was MACE at 1-year after TEVAR. MACE included acute myocardial infarction, cardiorespiratory arrest, stroke or death. Logistic regression analysis was used to identify predictors of one-year MACE.

Results: The study cohort included 41 patients (80.5% male) with a mean age of 70.2 ± 10.5 years. The 30-day mortality and MACE rates was 4.9% (n = 2) and 7.3% (n = 3), respectively. At one year, the mortality and MACE rates was 22.0% (n = 9) and 24.4% (n = 10), respectively. Patients who experienced MACE at one year had a significantly larger descending aorta diameter (74.2 ± 24.7 mm vs. 51.7 ± 17.4 mm; p = 0.003) and lower preoperative haemoglobin levels (11.4 ± 2.0 g/dL vs. 13.2 ± 2.2 g/dL; p = 0.036) compared to those without MACE. Multivariable analysis identified descending aortic diameter as an independent predictor of one-year MACE (OR 1.1; 95% confidence interval (CI), 1.0 - 1.2; p = 0.013).

Conclusion: Larger descending aortic diameter was an independent predictor of one-year MACE post-TEVAR. These findings underscore the critical importance of incorporating these parameters into preoperative risk stratification to optimize patient selection and improve long-term outcomes. By emphasizing careful preoperative assessment, we can enhance patient safety and surgical success, ultimately guiding clinical decision-making towards more personalized and effective therapeutic strategies.