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Abdominal aortic aneurysm surgery: the basic evaluation of cardiac risk
1Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232.
Insights
Detecting coronary artery disease (CAD) before abdominal aortic aneurysm (AAA) surgery is crucial. Careful evaluation and monitoring allow low-risk surgery for patients without clinically evident CAD.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coronary artery disease (CAD) treatment before abdominal aortic aneurysm (AAA) surgery improves outcomes.
- Optimal CAD detection methods before AAA surgery remain debated.
Purpose of the Study:
- To evaluate the risk of cardiac complications in patients with AAA undergoing surgery.
- To assess the effectiveness of pre-operative CAD detection methods.
Main Methods:
- 160 AAA patients were stratified using Goldman's risk factors.
- Pre-operative CAD assessment included clinical evaluation, stress ECG, and radionuclide studies.
- Perioperative monitoring involved serial ECGs, enzyme levels, filling pressures, and cardiac output.
Main Results:
- No operative mortality was observed.
- Incidence of myocardial infarction was 3.7%, heart failure 2.5%, and arrhythmias 8.1%.
- Cardiac complications were infrequent in patients without clinically evident CAD and those in Goldman's classes I and II.
Conclusions:
- Careful pre-operative evaluation and perioperative monitoring enable low-risk AAA surgery for patients without clinically detectable CAD.
- Goldman's risk stratification can aid in identifying high-risk patients.
Abstract:
The treatment of coronary artery disease (CAD) prior to abdominal aortic aneurysm (AAA) surgery has reduced the operative mortality, but there is no consensus regarding how best to detect CAD. In this study, 160 patients with AAA were divided into 4 groups according to Goldman's weighted risk factors. All patients were evaluated for CAD by clinical and laboratory methods, including stress electrocardiogram (ECG) and radionuclide studies, and monitored perioperatively with serial ECGs, measurements of serum enzymes, filling pressures, and cardiac output. No one died, but 3.7% had myocardial infarct, 2.5% had heart failure, and 8.1% had arrhythmias. Cardiac complications were rare in patients without clinically evident CAD and in those in Goldman's classes I and II. It appears that patients without clinically detectable CAD can be operated upon with a low risk if they are carefully evaluated and monitored.