RESUMO
BACKGROUND: Left ventricular (LV) remodeling remains unknown in patients with acute Type B aortic dissection (aTBAD) after thoracic endovascular aortic repair (TEVAR) during follow-up. METHODS: Between May 2004 and January 2016, 163 consecutive patients (136 males, mean preoperative age: 51.06⯱â¯10.79â¯years) with aTBAD underwent TEVAR. A linear mixed model was used to evaluate risk factor influencing on LV remodeling and investigate longitudinal changes in LV thickness, diameter, volume, function and mass at preoperation, postoperation, short- and mid-term follow-up. RESULTS: Median follow-up time was 48.0â¯months (quartiles 1-3, 31-84â¯months, maximum 147â¯months). LV thickness and mass followed a continuous downward trend over time. Interventricular septal thickness at end-diastole significantly decreased at mid-term follow-up (time, pâ¯<â¯0.001: preoperative 11.59⯱â¯0.14â¯mm vs mid-term 10.82⯱â¯0.15â¯mm, pâ¯<â¯0.001; postoperative 11.40⯱â¯0.14â¯mm vs mid-term 10.82⯱â¯0.15â¯mm, pâ¯=â¯0.006). LV posterior wall thickness at end-diastole was markedly reduced at mid-term follow-up (time, pâ¯<â¯0.001: preoperative 10.89⯱â¯0.11â¯mm vs mid-term 10.02⯱â¯0.11â¯mm, pâ¯<â¯0.001; postoperative 10.78⯱â¯0.13â¯mm vs mid-term 10.02⯱â¯0.11â¯mm, pâ¯<â¯0.001; short-term 10.56⯱â¯0.15â¯mm vs mid-term 10.02⯱â¯0.11â¯mm, pâ¯=â¯0.021). LV mass index markedly decreased during follow-up (time, pâ¯=â¯0.001: preoperative 129.60⯱â¯3.55â¯g/m2 vs short-term 119.26⯱â¯3.19â¯g/m2, pâ¯=â¯0.009; preoperative 129.60⯱â¯3.55â¯g/m2 vs mid-term 115.79⯱â¯3.62â¯g/m2, pâ¯=â¯0.003). LV function was improved, but not significantly so, during follow-up. Strict blood pressure control had no influence on LV remodeling. True lumen followed a continuous enlargement trend in terms of proximal thoracic aorta and celiac trunk level during follow-up. CONCLUSIONS: TEVAR can reverse LV remodeling and LV hypertrophy in patients with aTBAD during follow-up.
