The Effect Of Endovascular Aortic Aneurysm Repair On Cardiac Function In Patients With Heart Failure
Dimitrios Koudoumas, MD, PhD1, Nader Nader, MD, PhD2, Mariel Riveo, MD2, Linda Harris, MD1, Maciej Dryjski, MD, PhD1, Hasan Dosluoglu, MD2.
1SUNY Buffalo, Buffalo, NY, USA, 2VA Western New York Health Care System, Buffalo, NY, USA.
Cardiac dysfunction and concomitant abdominal aortic aneurysm (AAA) has been reported as high as 24%. We sought to identify the effect of endovascular aortic aneurysm repair (EVAR) on cardiac function in patients with pre-existing heart failure with reduced ejection fraction (<50%) (HFREF).
A retrospective chart review was performed in all patients undergoing EVAR with concomitant HFREF between 2004 and 2015. Patient demographics, preoperative, early (<6 months) and late (>6 months) postoperative echocardiograms were reviewed along with preoperative and postoperative computed tomography studies during the same time intervals.
From 498 patients with AAA undergoing EVAR, 71 (14.2%) were found to have pre-existing HFREF. From this cohort 42 patients were excluded from the study secondary to lack of follow up echocardiogram (n=27), cardiac intervention or cardiac surgery (n=15) yielding a total of 29 patients as a study population. All patients were male 29/29 (100%), hypertension was present in 28/29 patients (96.5%), hyperlipidemia in 27/29 (93.1%), coronary artery disease in 25/29 (86.2%), diabetes mellitus in 9/29 (31%), end stage renal disease not requiring dialysis in 8/29 (27.5%), atrial fibrillation in 6/29 (20.6%) and chronic obstructive pulmonary disease in 4/29 (13.7%). Cook endograft was used in 10/29 patients (34.4%), Gore in 9/29 (31%), Endologix in 6/29 (20.6%), Medtronic in 3/29 (10.3%) and Trivascular in 1/29 (3.7%). One patient developed a type II endoleak (3.7%). Mean age was 71.4 ± 9 years, BSA 2.04 ± 0.18 M2, BMI 30.0 ± 3.9 Kg/M2 and main graft body diameter was 30 ± 3.9 mm. Late postoperative left ventricular end diastolic diameter (LVEDD) was 56.6 ± 8.8 mm vs. 58.7 ± 7.31 mm preoperatively (p= .018). Left ventricular end systolic diameter (LVESD) posterior wall (PW) and interventricular septum (IVS) diameters were not statistical significant. Early postoperative LVEF was 30.0 ± 8.3% vs. 37.1 ± 8.4% (p= .015) late post implantation. Postoperative AAA diameter was 5.2 ± 1.1 mm vs. 6.1 ± 1 mm (p= .001) preoperatively. There was a positive correlation between postoperative EF and main body diameter with correlation coefficient of 0.39 (p= .03).
In this retrospective study EVAR was associated with an initial transient deterioration of the cardiac function up to 6 months, which recovered afterwards. Due to the small number of patients further studies are necessary.
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