title: Predictors of cardiac morbidity and mortality in patients undergoing endovascular repair of the thoracic aorta.
abstract: The aim of this study was to determine predictors of cardiac morbidity and mortality in patients undergoing endovascular repair of the thoracic aorta. This was a retrospective cohort study that took place in a University-affiliated county hospital. Preoperative and intraoperative variables were collected from a consecutive series of patients who underwent repair of the thoracic aorta at our institution between 1998 and 2003. Perioperative complications and mortality were identified for each patient. Fifty-nine patients underwent endovascular repair of the thoracic aorta. The endografts were successfully deployed in 58 (98%) patients. Nine (15%) died perioperatively, 4 (7%) from cardiac causes. There were 12 (20%) perioperative cardiac events. A history of myocardial infarction (MI) was the only preoperative risk factor that was predictive of a cardiac event (p = 0.001). The cardiac event rate was 29% for patients who did not receive perioperative beta-blockade vs. 8% in patients who did (p = 0.04). Intraoperative predictors of MI were estimated blood loss (2480 cc vs. 680 cc, p = 0.01), intravenous (i.v.) fluids (2955 cc vs. 2010 cc, p =0.02), and length of operation (269 min vs. 178 min, p = 0.02). From these results we concluded that mortality associated with endovascular repair of thoracic aorta remains significant. Patients with a history of MI had a higher perioperative cardiac event rate. Intraoperative predictors of perioperative cardiac events included blood loss, i.v. fluid requirement, and length of operation. Perioperative beta-blockade is important in endovascular thoracic surgery as a protection against postoperative cardiac events.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
authors.forename: Hao
authors.initials: H
authors.lastname: Bui
authors.forename: Jason
authors.initials: J
authors.lastname: Haukoos
authors.forename: Carlos
authors.initials: C
authors.lastname: Donayre
authors.forename: Rodney
authors.initials: R
authors.lastname: White
authors.forename: Christian
authors.initials: C
authors.lastname: de Virgilio
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality*; D001983:Bronchial Fistula / Q000401:mortality / Q000601:surgery; D005260:Female; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016157:Vascular Fistula / Q000401:mortality / Q000601:surgery