# Myocardial Injury During the Immediate Postoperative Period After Endovascular Aortic Repair: A Prospective Observational Study

## TL;DR

This study finds that general anesthesia, older age, and longer surgeries are linked to higher heart injury markers after aortic repair.

## Contribution

The study identifies specific risk factors for myocardial injury after EVAR using hs-cTnI levels in a prospective observational design.

## Key findings

- General anesthesia is associated with significantly higher postoperative hs-cTnI levels compared to regional anesthesia.
- Older age, longer operation duration, and higher baseline hs-cTnI predict higher postoperative hs-cTnI.
- Higher preoperative hemoglobin levels are linked to lower postoperative hs-cTnI levels.

## Abstract

Background/Objectives: Several studies in the literature support that endovascular aortic repair (EVAR) could exert a harmful effect on heart function, causing myocardial injury. The aim of this study is to investigate the correlation of high-sensitivity cardiac troponin I (hs-cTnI) levels during the immediate postoperative period after EVAR with various factors. Methods: A total of 104 patients were enrolled from February to December 2024 prospectively and consecutively. Patient demographics, cardiovascular comorbidities, laboratory tests, including hemoglobin and hs-cTnI levels, EVAR procedure duration and type of anesthesia were recorded. A generalized linear mixed model with a Gamma distribution and log link was fitted to analyze postoperative hs-cTnI concentrations across three time points (6 h, 24 h, and 48 h). Results: The mean age of patients was 71.6 ± 7.3 years, the mean transverse AAA diameter was 5.7 ± 1.1 cm and the mean preoperative hemoglobin was 14.2 ± 1.64 g/dL. In total, 72 patients received general anesthesia and 32 patients regional anesthesia. A total of 18 patients presented myocardial injury. Patients under general anesthesia had significantly higher mean hs-cTnI than those under regional anesthesia (p < 0.01). Older age, longer operations, and higher baseline hs-cTnI all predict higher follow-up hs-cTnI. Meanwhile higher preoperative hemoglobin predicts lower hs-cTnI. Conclusions: General anesthesia compared to regional anesthesia, older age, longer surgery, and higher baseline hs-cTnI are associated with higher postoperative hs-cTnI levels, while higher preoperative hemoglobin predicts lower hs-cTnI levels. Understanding the factors that are related to myocardial injury during EVAR could contribute to the improvement in procedures in order to minimize the harmful effect of EVAR on heart function.