Intra-mucosal acidosis as a predictor of cardiac outcome following abdominal aortic aneurysm surgery.
OBJECTIVE
To assess if sigmoid ischaemia is a prognostic indicator of early and late post-operative cardiac morbidity and mortality.


METHODS
Patients undergoing elective abdominal aortic aneurysm repair (AAAR) were included in the study. Demographic details and risk factors for heart disease were recorded. Sigmoid pHi was measured at the time of surgery using a silicone tonometer and perioperative morbidity and mortality were recorded in all patients. Seven years following surgery the patients and their general practitioners were contacted to determine the patient's health.


RESULTS
Thirty-eight patients were included in the study. Within the follow-up period, 22 (58%) had died. Eight patients died of cardiac failure or myocardial infarction. The pHi in patients with cardiac related deaths [6.99 (6.84-7.10)] was significantly lower than those with non-cardiac related deaths [7.11 (7.04-7.21), p<0.05]. Similarly, patients who suffered acute cardiac events (within 30 days following AAA repair) had lower pHi [7.01 (6.88-7.12)] compared to those who did not [7.09 (6.90-7.19), p<0.05].


CONCLUSIONS
The results show that sigmoid ischaemia is more frequent amongst patients that develop cardiac events after AAAR and is associated with a worse long term outcome. This suggests that global hypoperfusion as a result of an under performing heart may be partly responsible for the sigmoid ischaemia in patients following AAAR. Therefore, low sigmoid pHi may predict an increased risk of cardiac complications in these patients.
Reid
J A
JA
Vascular Unit, Belfast City Hospital, Belfast, Northern Ireland, UK. julieann.reid@ virgin.net
Annamalai
G
G
Lau
L L
LL
Soong
C V
CV
D000138:Acidosis / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D012809:Colon, Sigmoid / Q000473:pathology; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D013223:Statistics as Topic; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures