Background

Major vascular surgery is associated with a high perioperative risk and significant mortality. Despite advances in risk stratification, monitoring, and management of perioperative complications, cardiac complications are still common. Stress echocardiography is well established in coronary artery disease diagnostics; however, its prognostic value before high-risk aortic surgery is unknown. This prospective, single-center study compared the outcome of patients undergoing extended cardiac risk assessment before open abdominal aortic surgery with the outcome of patients who had received standard preoperative assessment.

Methods

The study included patients undergoing elective open abdominal aortic surgery. Patients who underwent standard preoperative assessment before the start of a dedicated protocol were compared with patients who had extended cardiac risk assessment, including dobutamine stress echocardiography, as part of a stepwise interdisciplinary cardiovascular team approach. The combined primary endpoint was cardiovascular death, myocardial infarction, emergency coronary revascularization, and life-threatening arrhythmia within 30 days. The secondary endpoint was acute renal failure and severe bleeding.

Results

In total, 77 patients (mean age 68.1 ± 8.1 years, 70% male) were included: 39 underwent standard and 38 underwent cardiac risk assessment. The combined primary endpoint was reached significantly more often in patients before than after implementation of the extended cardiac stratification procedure (15% vs. 0%, p = 0.025). The combined secondary endpoint did not differ between the groups.

Conclusions

Patients with extended cardiac risk assessment undergoing elective open abdominal aortic surgery had better 30-day outcomes than did those who had standard preoperative assessment.

中文翻译：

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择期开腹主动脉手术前扩展心脏风险评估的预后价值

背景

大血管手术与高围手术期风险和显着死亡率相关。尽管围手术期并发症的风险分层、监测和管理方面取得了进展，但心脏并发症仍然很常见。负荷超声心动图在冠状动脉疾病诊断中已得到广泛应用。然而，其在高风险主动脉手术前的预后价值尚不清楚。这项前瞻性、单中心研究将开放腹主动脉手术前接受扩展心脏风险评估的患者的结果与接受标准术前评估的患者的结果进行了比较。

方法

该研究包括接受选择性开放腹主动脉手术的患者。将在专门方案开始前接受标准术前评估的患者与进行了扩展心脏风险评估（包括多巴酚丁胺负荷超声心动图）的患者进行比较，作为逐步跨学科心血管团队方法的一部分。合并的主要终点是 30 天内心血管死亡、心肌梗塞、紧急冠状动脉血运重建和危及生命的心律失常。次要终点是急性肾功能衰竭和严重出血。

结果

总共包括 77 名患者（平均年龄 68.1 ± 8.1 岁，70% 为男性）：39 名患者接受了标准评估，38 名患者接受了心脏风险评估。在实施扩展心脏分层手术之前，患者达到综合主要终点的频率明显高于实施后的患者（15% vs. 0%，p  = 0.025）。合并的次要终点在各组之间没有差异。

结论

与接受标准术前评估的患者相比，接受扩展心脏风险评估并接受选择性腹主动脉开放手术的患者 30 天结果更好。