Complications associated with thoracic endovascular aortic repair: highlighting the role of peri- and post-operative cardiac monitoring

INTRODUCTION: Thoracic endovascular aortic repair (TEVAR) is first-line therapy for most descending thoracic aortic pathologies, yet it is performed in patients with a heavy burden of coronary disease, hypertension and limited cardiac reserve, and its cardiac complications remain underemphasized relative to neurological and device-related events. AREAS COVERED: We summarize the complication profile of TEVAR briefly and then concentrate on its cardiac dimension: myocardial injury after non-cardiac surgery, arrhythmia, acute heart failure, and the chronic ventricular consequences of stent-graft-induced aortic stiffening. We review the mechanisms linking endograft deployment to ventricular-arterial uncoupling, the echocardiographic markers of interest, blood pressure management, and a phase-based framework for peri- and post-operative cardiac monitoring, distinguishing guideline-supported recommendations from expert opinion and from evidence extrapolated from general vascular surgery. PubMed/MEDLINE were searched from database inception to August 2026. EXPERT OPINION: Cardiac surveillance around TEVAR is inconsistent and largely informal. We argue for baseline echocardiography in all elective patients, protocolized high-sensitivity troponin and natriuretic peptide measurement, defined-duration rhythm monitoring, structured blood pressure control, and longitudinal assessment of ventricular-arterial coupling within a heart-team pathway. TEVAR-specific outcome data and Windkessel-preserving graft design are the priorities for the next phase of endovascular aortic care.