Comparison of the incidences of cardiac arrhythmias, myocardial ischemia, and cardiac events in patients treated with endovascular versus open surgical repair of abdominal aortic aneurysms.
This study examines differences in cardiac arrhythmias, perioperative myocardial ischemia, troponin T release, and cardiovascular events between endovascular and open repair of abdominal aortic aneurysms (AAAs). Of 175 patients, 126 underwent open AAA repair and 49 underwent endovascular AAA repair. Continuous 12-lead electrocardiographic monitoring, starting 1 day before surgery and continuing through 2 days after surgery, was used for cardiac arrhythmia and myocardial ischemia detection. Troponin T was measured on postoperative days 1, 3, and 7 and before discharge. Cardiac events (cardiac death or Q-wave myocardial infarction) were noted at 30 days and at follow-up (mean 2.3 years). New-onset atrial fibrillation, nonsustained ventricular tachycardia, sustained ventricular tachycardia, and ventricular fibrillation occurred in 5%, 17%, 2%, and 1% of patients, respectively. Myocardial ischemia, troponin T release, and 30-day and long-term cardiac events occurred in 34%, 29%, 6%, and 10% of patients, respectively. Significantly higher heart rates and less heart rate variability were observed in the open AAA repair group. Cardiac arrhythmias were less prevalent in the endovascular AAA repair group (14% vs 29%, p = 0.04). Endovascular repair was also significantly associated with less myocardial ischemia (odds ratio 0.14, 95% confidence interval 0.05 to 0.40, p <0.001) and troponin T release (odds ratio 0.10, 95% confidence interval 0.02 to 0.32, p <0.001) and lower 30-day mortality (zero vs 8.7%, p = 0.03) and 30-day cardiac event rates (zero vs 7.9%, p = 0.04). Long-term mortality and cardiac event rates were not significantly lower in the endovascular AAA repair group. In conclusion, endovascular AAA repair is associated with a lower incidence of perioperative cardiac arrhythmias, myocardial ischemia, troponin T release, cardiac events, and all-cause mortality compared with open AAA repair.
Feringa
Harm H H
HH
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Karagiannis
Stefanos
S
Vidakovic
Radosav
R
Noordzij
Peter G
PG
Brugts
Jasper J
JJ
Schouten
Olaf
O
van Sambeek
Marc R H M
MR
Bax
Jeroen J
JJ
Poldermans
Don
D
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D001281:Atrial Fibrillation / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology*; D011446:Prospective Studies; D015607:Stents; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D014656:Vascular Surgical Procedures
D020107:Troponin T