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Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair†
S W Grant1, G L Hickey2, N A Wisely3
1Academic Surgery Unit, Education and Research Centre and National Institute for Cardiovascular Outcomes Research, Institute of Cardiovascular Science, University College London, London, UK.
Insights
Cardiopulmonary exercise testing (CPET) identifies patients at risk of reduced survival after abdominal aortic aneurysm (AAA) repair. Abnormal CPET results predict lower 3-year survival rates, aiding clinical decisions.
Area of Science:
- Vascular Surgery
- Cardiopulmonary Physiology
- Surgical Risk Assessment
Background:
- Cardiopulmonary exercise testing (CPET) is increasingly utilized for preoperative risk stratification in major surgeries.
- Identifying patients at risk of reduced survival post-abdominal aortic aneurysm (AAA) repair is crucial for surgical planning.
Purpose of the Study:
- To determine if CPET can predict survival outcomes in patients undergoing elective AAA repair.
- To identify specific CPET parameters associated with reduced long-term survival.
Main Methods:
- Prospective analysis of 506 patients undergoing elective open or endovascular AAA repair (EVAR) between 2007-2012.
- Symptom-limited maximal CPET performed preoperatively.
- Multivariable Cox proportional hazards regression used to identify survival predictors.
Main Results:
- 3-year survival was significantly lower (59.9%) in patients with three abnormal CPET values compared to those with zero or one (86.4%).
- Independent predictors of reduced survival included female sex, diabetes, lower hemoglobin, peak oxygen uptake <15 ml/kg/min, and anaerobic threshold >42 W.
- In-hospital mortality was 2.6% with a median follow-up of 26 months.
Conclusions:
- CPET variables are independent predictors of survival after elective AAA repair.
- CPET effectively identifies patients with significantly reduced 3-year survival post-procedure.
- CPET serves as a valuable tool to aid clinical decision-making for AAA patients.
Background:
Cardiopulmonary exercise testing (CPET) is increasingly used in the preoperative assessment of patients undergoing major surgery. The objective of this study was to investigate whether CPET can identify patients at risk of reduced survival after abdominal aortic aneurysm (AAA) repair.
Methods:
Prospectively collected data from consecutive patients who underwent CPET before elective open or endovascular AAA repair (EVAR) at two tertiary vascular centres between January 2007 and October 2012 were analysed. A symptom-limited maximal CPET was performed on each patient. Multivariable Cox proportional hazards regression modelling was used to identify risk factors associated with reduced survival.
Results:
The study included 506 patients with a mean age of 73.4 (range 44-90). The majority (82.6%) were men and most (64.6%) underwent EVAR. The in-hospital mortality was 2.6%. The median follow-up was 26 months. The 3-year survival for patients with zero or one sub-threshold CPET value ([Formula: see text] at AT<10.2 ml kg(-1) min(-1), peak [Formula: see text]<15 ml kg(-1) min(-1) or [Formula: see text] at AT>42) was 86.4% compared with 59.9% for patients with three sub-threshold CPET values. Risk factors independently associated with survival were female sex [hazard ratio (HR)=0.44, 95% confidence interval (CI) 0.22-0.85, P=0.015], diabetes (HR=1.95, 95% CI 1.04-3.69, P=0.039), preoperative statins (HR=0.58, 95% CI 0.38-0.90, P=0.016), haemoglobin g dl(-1) (HR=0.84, 95% CI 0.74-0.95, P=0.006), peak [Formula: see text]<15 ml kg(-1) min(-1) (HR=1.63, 95% CI 1.01-2.63, P=0.046), and [Formula: see text] at AT>42 (HR=1.68, 95% CI 1.00-2.80, P=0.049).
Conclusions:
CPET variables are independent predictors of reduced survival after elective AAA repair and can identify a cohort of patients with reduced survival at 3 years post-procedure. CPET is a potentially useful adjunct for clinical decision-making in patients with AAA.
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