Hao Bui

Preoperative Cardiac Evaluation and Interventions Before Aortic Surgery: Are They Justified?

The role of cardiac risk assessment and preoperative cardiac intervention prior to elective vascular surgery remains controversial. In high cardiac risk patients (severe or unstable angina, recent myocardial infarction, decompensated congestive heart failure [CHF]), the risk of an adverse cardiac event is so great that most would agree that these patients should undergo a preoperative cardiac work-up. In most instances strong consideration in these patients should be given to proceeding directly to coronary arteriography In patients with low cardiac risk (those with no active cardiac symptoms, and no Eagle risk factors [angina, age >70 years, history of CHF, Q-wave on EKG, diabetes, ventricular ectopy requiring medication]), the adverse cardiac event rate is so low that one can proceed safely to vascular surgery without any additional cardiac testing. The moderate risk group (patients with one or more Eagle risk factors but without severe or recent cardiac symptoms) may potentially benefit from aggressive...

530 FACTORS AFFECTING LONG-TERM MORTALITY AFTER ENDOVASCULAR REPAIR OF ABDOMINAL AORTIC ANEURYSMS.

Background Endovascular repair of abdominal aortic aneurysms (AAAs) has made considerable advancements with respect to perioperative mortality. However, fewer data are available regarding whether perioperative factors affect long-term mortality. Methods We reviewed a prospective database of 468 patients from 1996-2004 who underwent endovascular infrarenal AAA repair. We analyzed preoperative, intraoperative, and immediate postoperative factors, using multivariate Cox proportional hazards models, to identify independent predictors of long-term survival (survival for at least 30 days after hospital discharge). Results The mean age for our study population was 74 years and 90% were male. Median follow-up was 938 days (IQR 335-1479). Median overall survival was 2,203 days (IQR 1093-2792). The leading cause of death was cardiac. On multivariate analysis, the number of preoperative clinical cardiac risk factors (p = .0001), spending 2 or more days in the intensive care unit (p < .0001), and having an ST segment elevation myocardial infarction (STEMI) in the perioperative period (p < .0001) were predictors of long-term mortality, as was the absence of an endoleak (p = .0013). A perioperative non-STEMI was not predictive of mortality. On multivariate analysis, only the number of preoperative clinical cardiac risk factors (p = .0001), spending 2 or more days in the ICU (p = .0006), and having a STEMI were predictors of long-term mortality. Conclusions The leading cause of long-term mortality following endovascular AAA repair is cardiac. Preoperative variables such as clinical cardiac risk factors are significant predictors of long-term mortality following endovascular AAA repair, as is prolonged ICU stay and having a perioperative STEMI, whereas a perioperative non-STEMI is not. These findings provide guidelines for which patients are at greatest risk for long-term cardiac death following endovascular AAA repair and suggest that monitoring perioperative cardiac enzymes is unnecessary.