Heart Failure with Reduced EF and Mortality After TEVAR for Type B Dissection

Abstract Thoracic endovascular aortic repair (TEVAR) is established for type B aortic dissection (TBAD), but the longer-term relevance of baseline left ventricular systolic dysfunction remains uncertain. To explore the association between preprocedural heart failure with reduced ejection fraction (HFrEF) and all-cause mortality after TEVAR for TBAD. We retrospectively studied consecutive patients with TBAD who underwent TEVAR at a tertiary cardiovascular center from 2014 through 2022. HFrEF was defined as left ventricular ejection fraction ≤40%. Survival was estimated by Kaplan-Meier analysis, and exploratory univariable Cox regression was used because only 16 deaths occurred. Of 81 eligible patients 14 were lost to follow-up and excluded from the primary time-to-event analysis; a post hoc extreme-case analysis bounded the crude mortality proportion among all eligible patients. Sixty-seven patients were analyzed over a mean follow-up of 49.2 months (95% confidence interval [CI]: 44.2–54.3); 16 died (23.9%). Seven patients had HFrEF, including five deaths. HFrEF was associated with higher mortality (hazard ratio, 5.65; 95% CI: 1.95–16.36; p = 0.001). Estimated mean survival was 24.2 months (95% CI: 5.7–43.1) with HFrEF and 52.2 months (95% CI: 47.5–56.9) without HFrEF. Depending on the unknown outcomes of the 14 patients lost to follow-up, crude mortality among all 81 eligible patients would range from 19.8 to 37.0%. Baseline HFrEF showed a strong unadjusted association with long-term mortality after TEVAR for TBAD. The small exposed subgroup, limited event count, unmeasured confounding, and attrition preclude claims of an independent or TEVAR-specific prognostic effect; the finding is hypothesis-generating.