Implications of Procedure of Thoracic Endovascular Aortic Repair on Left Ventricular Global Longitudinal Strain

OBJECTIVE
Aorta, particularly in its proximal segments, expands during systole to store blood, which is subsequently released into the peripheral circulation during diastole, morphologically and histologically. This function, referred to as the "Windkessel effect," ensures continuous and regular blood flow in the peripheral circulation. Thoracic Endovascular Aortic Repair (TEVAR) was introduced in the literature as a treatment for Type B aortic dissections (TBAD). In patients who undergo TEVAR, the placement of a stent graft in the proximal segments of the aorta, which are responsible for the highest capacity of blood storage and elasticity, may disrupt this function. Consequently, this alteration may lead to increased afterload and, over the long term, impair left ventricular systolic function. Previous studies have demonstrated that measurements of left ventricular global longitudinal strain (LVGLS) can detect early systolic dysfunction before any significant changes in left ventricular ejection fraction (LVEF) occur. The aim of this study is to compare preoperative and postoperative LVGLS measurements in patients who underwent TEVAR, thereby illustrating changes in LVGLS associated with the procedure.

METHODS
Patients who underwent TEVAR for TBAD or Thoracic Aortic Aneurysm (TAA) were included in the study. Patients with malignancy, advanced valvular pathology, end-stage chronic kidney disease, liver failure, or heart failure were excluded. Preoperative data, including comorbidities, medication use, blood parameters, electrocardiography findings, transthoracic echocardiography images, and LVGLS values, were recorded. These parameters were then compared with the values obtained at the postoperative 3-month outpatient follow-up.

RESULTS
After TEVAR procedure, a significant decrease in LVGLS was observed (p<0.001). A strong correlation was found between the change in mean arterial pressure (MAP) and the reduction in LVGLS (ρ=0.555, p=0.017). Postoperatively, significant increases were noted in systolic blood pressure (SBP) and MAP (both p<0.001). No significant differences were observed in other parameters before and after the procedure.

CONCLUSION
In our study, a significant increase in SBP and MAP, along with a notable decrease in LVGLS values, were observed following TEVAR procedure. A significant and strong correlation was identified between the increase in MAP and the decrease in LVGLS.