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Home > Vascular Annual Meeting > RR14. Perioperative Cardiac Events in Endovascular...

RR14. Perioperative Cardiac Events in Endovascular Thoracoabdominal Aneurysm Repair: Association with Preoperative Studies and Long-Term Prognosis

Guilherme Linhares Bub, Tara M. Mastracci, Roy Greenberg
The Cleveland Clinic Foundation, Cleveland, OH

OBJECTIVES: Cardiac complications are common following repair of thoracoabdominal aneurysms. Endovascular repair obviates the need for aortic cross-clamping, large incisions, and marked fluid shifts, yet has still been associated with significant cardiac morbidity. This study was undertaken to evaluate cardiac morbidity following endovascular thoracoabdominal aneurysm repair.

METHODS: A single-center trial over a 5 year period included all patients who underwent thoracoabdominal aneurysm repair with branched devices was reviewed to evaluate cardiac complications within 30 days of implantation, including: STEMI, NSTEMI (including troponin >0.1), and fatal arrhythmias. Preoperative characteristics (echocardiographic results, functional testing, and cardiac related symptoms) were compared using univariate analyses, and independent risk factors for perioperative cardiac events were determined using a multivariate analysis. Analyses were also performed to determine association between perioperative rise in troponin and long term death.

RESULTS: In total, 395 patients underwent endovascular thoracoabdominal repair in the period between 2003 and December 2007. Post operative troponin levels peaked to >0.1 ng/mL in 12% (33/268) of the patients. The mean peak troponin was 0.5 ng/mL (SD 0.51) in this subset of patients, most commonly on post operative day 4 (SD 1.54). There were 2 cardiac-related death (both with troponin levels >0.1, 2/33, 6%) in the perioperative period. Of the patients that had cardiac complications, 30 had echocardiography documented and 5 had cardiac catheterizations preoperatively.

CONCLUSIONS: Lethal cardiac complications are uncommon following endovascular thoracoabdominal aneurysm repair. However, troponin levels (in excess of 0.1 ng/mL) are relatively common indicating that there may remain a significant cardiac risk. The optimal preoperative testing paradigm remains to be determined and should the subject of further evaluation.

AUTHOR DISCLOSURES: T.M. Mastracci , Cook Medical, Inc; R. Greenberg , Cook Medical, Inc; Gore; Terarecon; Cook Medical Inc; Cook Medical Inc.