title: Perioperative and late outcome in patients with left ventricular ejection fraction of 35% or less who require major vascular surgery.
abstract: Survival in patients with diminished left ventricular ejection fraction (EF) is reduced after major vascular surgery. The objective of this study was to determine perioperative (30-day) and subsequent outcome after major vascular surgery in those with severe cardiac dysfunction, defined by EF being 35% or less (normal EF greater than 50%). From Aug. 1, 1984 to Jan. 1, 1988, 35 patients with EF equal to 27.7% +/- 6.1% (mean +/- 1 standard deviation) have required 47 major vascular procedures: 53% (n = 25) were limb revascularizations; 21% (n = 10) were direct aortoiliac aneurysm repairs: 23% (n = 11) were carotid endarterectomies: one patient had transaortic renal endarterectomy. Two deaths occurred within the first 30 days, yielding a 4.3% perioperative mortality rate (2 of 47 procedures). The cumulative mortality rate for the entire group during follow-up of 410 +/- 390 days was 40% (14 of 35 patients). Most late deaths (71%) occurred within the first 6 months after surgery and each was due to cardiovascular complications. Survival for those with an EF of 29% or less was significantly worse than for those with an EF greater than 29%, determined by life-table analysis (p less than 0.012, Mantel-Cox). The cumulative mortality rate was 59% with an EF of 29% or less and 18% in those with an EF greater than 29% (p less than 0.029, two-tailed Fisher exact test). The perioperative mortality rate for those with an EF of 35% or less who require major vascular surgery is acceptable, but overall survival during follow-up is diminished.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D000206:Actuarial Analysis; D000368:Aged; D001012:Aorta, Abdominal; D001014:Aortic Aneurysm / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002340:Carotid Artery Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004691:Endarterectomy; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012077:Renal Artery / Q000601:surgery*; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors