CPET and cardioesophagectomy: A single centre 10-year experience.

Abstract

INTRODUCTION\nCPET is a routine investigation prior to cardioesophagectomy. Over a 10-year period 200 patients had CPET before elective cardioesophagectomy. We examine the relationship between CPET and outcomes in these patients.\n\n\nMATERIALS AND METHODS\nComplication data were prospectively collected using the Clavien-Dindo system. Logistic regression analysis was used to determine whether 90-day mortality and morbidity were significantly different between fitter and less fit patients.\n\n\nRESULTS\n90-day mortality was 5.5%. In univariate analysis the following factors were associated with a significantly increased risk of death at 90 days: anaerobic threshold <11\u202fml\u202fkg-1\u202fmin-1 OR (95% CI)\u202f=\u202f4.38 (1.23,15.6), p\u202f=\u202f0.023; V̇O2 peak <15\u202fml\u202fkg-1\u202fmin-1 O2 OR (95% CI)\u202f=\u202f5.0 (1.42,15.55), p\u202f=\u202f0.012; V̇E/V̇CO2\u202f>\u202f34 OR (95% CI)\u202f=\u202f4.07 (1.19,14.0), p\u202f=\u202f0.026; diabetes mellitus OR (95% CI)\u202f=\u202f5.76 (1.55,21.35) p\u202f=\u202f0.009. In multivariate logistic regression analysis both diabetes (OR\u202f=\u202f5.76 [1.55,21.4] p\u202f=\u202f0.009) and presence of\u202f≥\u202f1 subthreshold CPET value (OR\u202f=\u202f6.72 [1.32,29.8] p\u202f=\u202f0.021) were significantly associated with increased risk of death at 90 days. Median (95% CI) survival for patients who had a CPET with normal parameters was 1176 (565, 1787) days, compared with 642 (336, 948) days for patients with\u202f≥\u202fone subthreshold parameter. 15.5% of patients had ECG ischaemia; there were no deaths in this group.\n\n\nCONCLUSION\nPresence of at least one sub-threshold CPET value at pre-operative testing is associated with increased risk of 90-day mortality and shorter long term survival. These results allow us to better define risks during shared decision-making with patients.