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CPET and cardioesophagectomy: A single centre 10-year experience
Steve Benington1, Angella Bryan2, Owen Milne1
1Department of Anaesthesia & Intensive Care, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK.
Summary
Cardiopulmonary exercise testing (CPET) identifies patients at higher risk for 90-day mortality after cardioesophagectomy. Abnormal CPET results predict increased mortality and reduced long-term survival, aiding in patient risk assessment.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Cardiopulmonary exercise testing (CPET) is standard before cardioesophagectomy.
- A 10-year study analyzed 200 patients undergoing CPET prior to elective cardioesophagectomy.
- This research investigates the link between CPET findings and patient outcomes.
Purpose of the Study:
- To determine the relationship between CPET results and post-cardioesophagectomy outcomes.
- To identify specific CPET parameters predictive of mortality and morbidity.
- To enhance risk stratification for patients undergoing elective cardioesophagectomy.
Main Methods:
- Prospective collection of complication data using the Clavien-Dindo system.
- Logistic regression analysis to compare outcomes between "fit" and "less fit" patients.
- Evaluation of factors associated with 90-day mortality, including anaerobic threshold, V̇O2 peak, and V̇E/V̇CO2 ratio.
Main Results:
- 90-day mortality was 5.5%.
- Factors significantly associated with increased 90-day mortality included anaerobic threshold <11 ml/kg/min, V̇O2 peak <15 ml/kg/min, V̇E/V̇CO2 >34, and diabetes mellitus.
- Multivariate analysis identified diabetes and at least one subthreshold CPET value as significant predictors of 90-day mortality.
- Patients with any subthreshold CPET value had a median survival of 642 days compared to 1176 days for those with normal CPET parameters.
Conclusions:
- The presence of at least one subthreshold CPET value indicates an elevated risk of 90-day mortality and reduced long-term survival.
- These findings improve the ability to define risks for patients during shared decision-making.
- CPET is a valuable tool for pre-operative risk assessment in cardioesophagectomy patients.
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