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Influence of coronary artery disease and left ventricular dysfunction on postoperative mortality in vascular surgery
H Nagaoka1, R Innami, N Funakoshi
1Department of Cardiovascular and Thoracic Surgery, Tsuchiura Kyodo General Hospital, Japan.
Insights
Left ventricular dysfunction significantly increases postoperative mortality in patients undergoing major vascular surgeries like AAA resections and aortoiliac reconstructions. Early intervention may reduce cardiac events and improve survival rates.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Health
Background:
- Coronary artery disease (CAD) and left ventricular dysfunction (LVD) are significant concerns in patients undergoing major vascular surgery.
- Assessing their impact on postoperative mortality is crucial for risk stratification and management.
Purpose of the Study:
- To evaluate the influence of CAD and LVD on postoperative mortality in patients undergoing abdominal aortic aneurysm (AAA) resections and aortoiliac (AI) or femoropopliteal (FP) reconstructions.
- To identify key risk factors for cardiac-related deaths in this patient cohort.
Main Methods:
- A retrospective review of 107 patients who underwent AAA, AI, or FP reconstructions.
- All patients had preoperative coronary angiograms and cardiac catheterization.
- Analysis of preoperative cardiac status, surgical procedure, and postoperative outcomes, including mortality.
Main Results:
- Severe CAD was present in 40.6% of AAA, 31.8% of AI, and 3.2% of FP patients.
- Severe LVD was found in 21.9% of AAA, 18.2% of AI, and 6.5% of FP patients.
- Cardiac events caused all early deaths and 45.5% of late deaths. Nine-year survival was significantly lower (53.3%) in patients with combined CAD and LVD.
Conclusions:
- Left ventricular dysfunction is a critical risk factor for postoperative mortality in AAA resection and AI reconstruction.
- Severe CAD and subsequent mortality may be mitigated by interventional coronary therapies.
- Preoperative cardiac assessment and risk stratification are vital for optimizing outcomes in vascular surgery patients.
Abstract:
In an attempt to assess the influence of coronary artery disease and left ventricular dysfunction on postoperative mortality, 107 patients consisting of 32 AAA resections and 44 aortoiliac and 31 femoropopliteal reconstructions were reviewed. All patients had a preoperative coronary angiograms and underwent cardiac catheterization to prevent cardiac-related deaths. Severe coronary artery disease was angiographically demonstrated in 40.6% of AAA, 31.8% of AI and 3.2% of FP patients. Severe left ventricular dysfunction was found in 21.9% of AAA, 18.2% of AI and 6.5% of FP. Both of the early and 5 (45.5%) of the 11 late deaths were caused by cardiac events. The nine-year survival rate (53.3%) in the patients with a documented combination of coronary artery disease and left ventricular dysfunction was significantly lower than those in patients with normal disease, normal left ventricular function and either documented coronary artery disease or left ventricular dysfunction. It is suggested from this series that left ventricular dysfunction is one of the most important risk factors in patients who undergo AAA resection and AI reconstruction and that severe disease and postoperative mortality are possibly reduced by certain kinds of interventional coronary therapies.