Preoperative haemodynamic parameters and the immediate outcome after open repair of ruptured abdominal aortic aneurysms.
OBJECTIVE
The aim of this study was to evaluate the impact of preoperative cardiac function and haemodynamic parameters on the immediate outcome after repair of ruptured abdominal aortic aneurysm (RAAA).


METHODS
This is a retrospective review of 68 consecutive patients who underwent emergency repair of RAAA. Baseline pulmonary artery pressure, cardiac index, oxygen saturation and pulse rate were measured and recorded immediately after insertion of a pulmonary artery thermodilution catheter and before anaesthesia induction.


RESULTS
The in-hospital mortality rate was 39.7%. The area under the receiver operating characteristic (ROC) curve of cardiac index was 0.74 (95% CI 0.61-0.86), of stroke volume index was 0.78 (95% CI 0.67-0.89) and for oxygen delivery 0.72 (95% CI 0.60-0.84) for prediction of in-hospital death. The best cut-off values of cardiac index was 2.7 l/min/m(2) (18.8% vs. 58.3%, OR 6.07, 95% CI 2.00-18.37), of stroke volume index was 27 ml/m(2) (23.1% vs. 62.1%, OR 5.46, 95% CI 1.90-15.70) and of oxygen delivery was 370 ml/min/m(2) (17.9% vs. 56.4%, OR 5.05, 95% CI 1.87-18.91). Multivariate analysis showed that patient's age (P=0.01, OR 1.23, 95% CI 1.05-1.44), stroke volume index (P=0.018, OR 0.89, 95% CI 0.81-0.98), and shock (P=0.007, OR 14.20, 95% CI 2.09-96.67) were independent predictors of in-hospital death.


CONCLUSIONS
This study suggests that impaired cardiac function and suboptimal oxyhaemodynamic parameters are important determinants of death after repair of RAAA.
Giordano
Salvatore
S
Department of Surgery, Vaasa Central Hospital, 65130 Vaasa, Finland. salvatoregiordano@yahoo.it
Biancari
Fausto
F
Loponen
Pertti
P
Wistbacka
Jan-Ola
JO
Luther
Michael
M
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D004638:Emergency Treatment; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010100:Oxygen / Q000097:blood; D011651:Pulmonary Artery / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
D010100:Oxygen