Cardiac response and complications during endovascular repair of abdominal aortic aneurysms: a concurrent comparison with open surgery.
OBJECTIVE
The purpose of this study was to assess and to compare perioperative changes in left ventricular function and the incidence of adverse cardiac events in two groups of patients with abdominal aortic aneurysms, one during endovascular aneurysm repair (EAR) and the other during open aneurysm repair (OAR).


METHODS
One hundred twenty consecutive patients who underwent EAR (49 patients) or OAR (71 patients) were prospectively studied. During the operation, the left ventricular function was assessed by the recording of the left ventricle stroke work index (SWI) and the cardiac index (CI) with a pulmonary artery catheter. Measurements were performed before, during, and after stent-graft deployment or aortic cross-clamping. Both maneuvers were defined as aortic occlusion (AO). Transesophageal echocardiography was performed to identify signs of wall motion abnormalities of the left ventricular wall, which indicated myocardial ischemia. Six-lead electrocardiograph monitoring was maintained until discharge from the intensive care unit. Postoperative cardiac complications were diagnosed by clinical observation, 12-lead ECG analysis at 1, 3, and 7 days after the operation, transthoracic echocardiography at 1 month, and measurement of cardiac enzymes.


RESULTS
The two study groups were comparable with regard to most clinical aspects. The baseline myocardial performance was worse in patients who underwent EAR compared with patients who underwent OAR, as indicated by a reduced SWI (33.1 and 37.4, respectively; P =.03). During AO there was a comparable increase of the CI in both groups. However, after AO the rise in CI was higher in patients who underwent OAR compared with patients who underwent EAR (0.7 and 0.2, respectively; P <.01), representing a more pronounced hyperdynamic state. In addition, the SWI demonstrated a decrease in patients who underwent OAR compared with an increase in patients who underwent EAR during AO (-1.4 and +1.9, respectively; P =.04) and after AO (-0.9 and +2.6, respectively; P =.01). These findings represent more severe myocardial stress in patients who underwent OAR. The incidence of postoperative clinical cardiac adverse events was comparable in the two study groups. However, myocardial ischemia, as indicated by electrocardiography and transesophageal echocardiography, had a higher incidence in patients who underwent open surgery as compared with patients whose condition was managed endovascularly (57% and 33%, respectively; P =.01).


CONCLUSIONS
Hemodynamic alterations during endovascular repair were not as severe as those in patients with open surgery and indicated less myocardial stress in the former category. These findings may explain a lower incidence of myocardial ischemia that was observed during endovascular repair. A lower frequency of clinical perioperative cardiac events in patients undergoing endovascular treatment may ultimately be expected.
Cuypers
P W
PW
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Gardien
M
M
Buth
J
J
Charbon
J
J
Peels
C H
CH
Hop
W
W
Laheij
R J
RJ
D001011:Aorta; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications; D008026:Ligation / Q000009:adverse effects; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications; D011446:Prospective Studies; D015607:Stents; D015996:Survival Rate; D016277:Ventricular Function, Left