Myocardial damage in high-risk patients undergoing elective endovascular or open infrarenal abdominal aortic aneurysm repair

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Cardiac Imaging

Background:

• Dobutamine stress echocardiography (DSE) objectively assesses coronary artery disease.
• Patients undergoing infrarenal aortic aneurysm (AAA) repair often have high cardiac risk.
• Comparing open vs. endovascular AAA repair outcomes in high-risk patients is crucial.

Purpose of the Study:

• To compare cardiac outcomes in high-risk patients undergoing open or endovascular infrarenal AAA repair.
• To utilize preoperative Dobutamine stress echocardiography (DSE) results for risk stratification.
• To evaluate perioperative myocardial damage and major adverse cardiac events.

Main Methods:

• Retrospective review of 77 high-risk patients (>or=3 cardiac risk factors) undergoing infrarenal AAA repair.
• All patients underwent preoperative Dobutamine stress echocardiography (DSE).
• Postoperative data collected included troponin levels, ECG, and major adverse cardiac events up to 30 days.

Main Results:

• 77 patients (39 endovascular, 38 open) with pre-existing cardiac disease were analyzed.
• Preoperative DSE showed similar levels of myocardial ischemia between open and endovascular groups.
• Endovascular repair was associated with significantly lower perioperative myocardial damage (13% vs. 47%, p=0.001) and fewer major adverse cardiac events (0% vs. 13%, p=0.02).

Conclusions:

• Endovascular AAA repair is associated with reduced perioperative myocardial damage in high-risk patients.
• DSE findings were similar between groups, highlighting the benefit of endovascular repair.
• This suggests endovascular repair may be a safer option for infrarenal AAA in patients with high cardiac risk.