Analysis of the Incidence, Risk Factors, and Prognosis of Early Acute Heart Failure After TEVAR for Complex Acute Type B Aortic Dissection

Abstract

Background:Complex acute type B aortic dissection (ATBAD) is an aortic emergency associated with high mortality. Thoracic endovascular aortic repair (TEVAR) has become the treatment of choice for complex ATBAD. However, early acute heart failure (AHF) after TEVAR can significantly increase perioperative mortality risk, and systematic studies on its incidence, multidimensional risk factors, and independent impact on mid- and long-term prognosis remain insufficient.Methods:A total of 225 patients with complex ATBAD who underwent TEVAR at our hospital from January 2021 to January 2025 were prospectively enrolled. Patients were divided into an AHF group (n = 34) and a non-AHF group (n = 191) according to whether AHF occurred within 30 days postoperatively. Baseline data, imaging characteristics, laboratory parameters, and perioperative data were collected. Univariable and multivariable binary logistic regression analyses were used to identify independent risk factors for AHF. Receiver operating characteristic (ROC) curves were plotted to evaluate predictive performance, and internal validation was conducted using Bootstrap resampling (B = 1000); Kaplan-Meier analysis and Cox proportional hazards regression (Fine-Gray competing risks model) were used to assess the impact of AHF on 1-year all-cause mortality.Results:Among 225 patients, the incidence of AHF within 30 days after TEVAR was 15.1% (34/225). Multivariable logistic regression identified four independent risk factors: preoperative B-type natriuretic peptide (BNP) ≥100 pg/mL (odds ratio [OR] = 7.84, 95% confidence interval [CI] 3.12–19.68), concomitant coronary artery disease (CAD) (OR = 3.10, 95% CI 1.05–9.13), admission heart rate per 10 beats/min increase (OR = 1.72, 95% CI 1.28–2.31), and stent coverage length per 10 mm increase (OR = 1.14, 95% CI 1.04–1.25) (all p < 0.05). The combined prediction model constructed from these four factors achieved an area under the curve (AUC) of 0.897 (95% CI 0.842–0.952); Bootstrap-corrected AUC was 0.868 (95% CI 0.801–0.935); the AUC for preoperative BNP alone was 0.842 (optimal cutoff 98.5 pg/mL). The AHF group had significantly higher 30-day all-cause mortality (17.6% vs 2.6%, p = 0.002) and 30-day major adverse cardiac and cerebrovascular events (MACCE) rate (35.3% vs 9.4%, p < 0.001) than the non-AHF group. Kaplan-Meier analysis showed a lower 1-year cumulative survival rate in the AHF group (73.5%) compared with the non-AHF group (93.7%, Log-rank p < 0.001). After adjusting for confounders, AHF remained an independent risk factor for 1-year all-cause mortality (hazard ratio [HR] = 4.32, 95% CI 1.86–10.04, p = 0.001).Conclusions:The incidence of early AHF after TEVAR in complex ATBAD patients is 15.1%. Preoperative BNP ≥100 pg/mL, concomitant CAD, elevated admission heart rate, and longer stent coverage length are independent risk factors. AHF independently increases perioperative and 1-year all-cause mortality risk.