[Ischemic heart disease and postoperative mortality in major vascular surgery. An up-to-date diagnostic approach].
BACKGROUND
The aim of this study is to evaluate the efficacy the dobutamine stress echocardiography in predicting the perioperative cardiac risk of patients undergoing major vascular surgery.


METHODS
Seventy-seven consecutive and not selected patients, undergoing a surgical treatment requiring aortic cross clamping, were assessed also with a transthoracic dobutamine stress echocardiography. With electrocardiographic and echocardiographic monitoring ventricular ischemia or wall motion abnormalities, 5 micrograms/kg per min of chlorhydrate dobutamine for 5 minutes were infused, followed by other 10 micrograms/kg per min increased up to 40 micrograms/kg per min. During the last 4 minutes 0.25 mg of atropin were infused increasingly up to 1 mg.


RESULTS
Of all these patients, 26 had a stress ischemia but only 4 cases underwent a coronary angiography and only 2 of these underwent a preventive myocardial revascularization. Due to poor cardiac conditions pointed out with the dobutamine stress, 3 patients were not treated surgically. With an aggressive intra- and perioperative monitoring 73 patients underwent a surgical treatment: they were 28 aorto-bifemoral, 3 aorto-aortic grafts, 1 aorto-bisiliac thoraco-abdominal interposition graft, and 20 aorto-bifemoral, 4 aorto-femoral, 1 aorto-aortic thoraco-abdominal, 1 aorto-renal by-pass and 7 aorto-iliac-femoral thromboendoarterectomies. In the postoperative period 4 cardiac ischemic complications and 2 deaths (2.5%) were observed.


CONCLUSIONS
According to our personal opinion, stress echocardiography can be considered a test with a excellent feasibility and safety rate, not expensive and with a good reproducibility and reliability. It allowed to predict the cardiac risk in our patients suggesting not only the surgical but also the anesthesiologic and the perioperative therapeutic management.
Adovasio
R
R
Istituto di Patologia Speciale Chirurgica, Università degli Studi, Trieste.
Pandullo
C
C
Nadal
A
A
Rauber
E
E
D003937:Diagnosis, Differential; D004280:Dobutamine; D004452:Echocardiography; D004691:Endarterectomy; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality; D012307:Risk Factors; D017131:Thrombectomy; D014656:Vascular Surgical Procedures / Q000401:mortality*
D004280:Dobutamine
Cardiopatia ischemica e mortalità operatoria in chirurgia vascolare maggiore. Un moderno approccio diagnostico.