A comparative study of myocardial injury during conventional and endovascular aortic aneurysm repair: measurement of cardiac troponin T and plasma cytokine release.
BACKGROUND
Major aortic surgery results in significant haemodynamic and oxidative stress to the myocardium. Cytokine release is a major factor in causing cardiac injury during aortic surgery. Endovascular aortic aneurysm repair (EVAR) has the potential to reduce the severity of the ischaemia reperfusion syndrome and its systemic consequences.


OBJECTIVE
The aim of this study was to investigate the occurrence of myocardial injury during conventional and endovascular abdominal aortic aneurysm repair using measurement of the myocardial-specific protein, cardiac troponin T. Interleukin-6 was also measured in both groups and haemodynamic responses to surgery assessed.


METHODS
Nine consecutive patients undergoing conventional infra-renal aortic aneurysm surgery were compared with 13 patients who underwent EVAR. Patients were allocated on the basis of aneurysm morphology and suitability for endovascular repair.


RESULTS
Patients undergoing open repair had significantly more haemodynamic disturbance than those having endovascular repair (mean arterial pressure at 5 min following unclamping or balloon deflation: open (69.6 + 3.3 mmHg); endovascular (86 + 4.4 mmHg), P < 0.05 vs. pre-op). Troponin T levels at 48 h post-operatively were higher in patients who underwent open repair (open 0.164 + 0.1 ng/ml; endovascular 0.008 + 0.0005 ng/ml, P < 0.04). Significantly more patients in the open repair group had troponin T levels > 0.1 ng/l when compared with the endovascular group (P < 0.01, chi (2) test)


CONCLUSIONS
Endovascular aortic surgery produces significantly less myocardial injury than the open technique of aortic aneurysm repair.
Barry
M C
MC
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. mary.barry@st-vincents.ie
Hendriks
J M
JM
van Dijk
L C
LC
Pattynama
P
P
Poldermans
D
D
Bouchier Hayes
D
D
van Urk
H
H
van Sambeek
M R H M
MR
D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery*; D001792:Blood Platelets; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016207:Cytokines / Q000097:blood*; D005260:Female; D006335:Heart Injuries / Q000209:etiology*; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D009206:Myocardium; D009504:Neutrophils; D018384:Oxidative Stress; D018570:Risk Assessment; D012720:Severity of Illness Index; D020107:Troponin T / Q000097:blood*
D016207:Cytokines; D015850:Interleukin-6; D020107:Troponin T