title: General anaesthesia is associated with adverse cardiac outcome after endovascular aneurysm repair.
abstract: OBJECTIVE
  Endovascular aneurysm repair (EVAR) is associated with reduced cardiac stress compared with open repair and is an attractive therapeutic option, especially in cardiac fragile patients. General and locoregional anaesthesia differ regarding the stress response evoked by surgery. The aim of the study is to compare the incidence of cardiac events after EVAR under general or locoregional anaesthesia.
  
  
  METHODS
  A total of 302 consecutive patients undergoing infrarenal EVAR between 2002 and 2011 were analysed in this retrospective cohort study. Selection of anaesthesia type was at the discretion of the treating physicians. Medical history, medication use, anaesthesia technique and follow-up were obtained. The study end point was 30-day cardiac complications, including cardiac death, non-fatal myocardial infarction, heart failure, ventricular arrhythmia and troponin T release. Multivariable analysis, adjusted for the propensity of receiving a locoregional technique and cardiac risk factors according to the Revised Cardiac Risk Index, was used to assess the association between cardiac events and anaesthesia type.
  
  
  RESULTS
  A total of 173 patients underwent general anaesthesia and 129 locoregional anaesthesia. Obesity, aspirin use and therapeutic anticoagulation were more common in patients receiving general anaesthesia. Cardiac events were observed in 13.3% of patients receiving general anaesthesia and in 4.7% of patients receiving locoregional anaesthesia (P = 0.02), or 6.4% versus .8% (P = 0.02) when asymptomatic troponin release is excluded from the end point. In the general anaesthesia group, two cardiac deaths, six non-fatal myocardial infarctions, two cases of non-fatal heart failure, one non-fatal cardiac arrest and 12 cases of troponin T release were observed, compared with one myocardial infarction and five cases of troponin T release in the locoregional anaesthesia group. In multivariable analysis, general anaesthesia was associated with adverse cardiac events (odds ratio (OR) 3.8; 95%-confidence interval (CI) 1.1-12.9). Non-cardiac complications occurred in 11.6% of patients in both groups (P = 1.00).
  
  
  CONCLUSIONS
  General anaesthesia was associated with an increased risk of cardiac events in EVAR, compared with locoregional anaesthesia.
authors.affiliation: Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
authors.forename: E J
authors.initials: EJ
authors.lastname: Bakker
authors.forename: K M
authors.initials: KM
authors.lastname: van de Luijtgaarden
authors.forename: F
authors.initials: F
authors.lastname: van Lier
authors.forename: T M
authors.initials: TM
authors.lastname: Valentijn
authors.forename: S E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: M
authors.initials: M
authors.lastname: Klimek
authors.forename: H J M
authors.initials: HJ
authors.lastname: Verhagen
authors.forename: R J
authors.initials: RJ
authors.lastname: Stolker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000009:adverse effects* / Q000401:mortality; D000768:Anesthesia, General / Q000009:adverse effects* / Q000401:mortality; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome