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The Impact of Chronic Limb-Threatening Ischemia on Cardiac Surgery

Naohiro Wakabayashi1, Shinsuke Kikuchi2, Naoya Kuriyama2

  • 1Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan.

Frontiers in Surgery
|May 16, 2022
PubMed

Insights

Cardiac surgery in patients with chronic limb-threatening ischemia (CLTI) is high-risk, especially for those with advanced Wound, Ischemia, and foot Infection (WIfI) stages. Pre-operative revascularization may improve outcomes for high-risk CLTI patients undergoing cardiac surgery.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Clinical Outcomes Research

Background:

  • Chronic limb-threatening ischemia (CLTI) often coexists with advanced cardiac disease requiring surgical intervention.
  • The impact of CLTI severity on cardiac surgery outcomes is not well-documented.

Purpose of the Study:

  • To evaluate cardiac surgery outcomes in patients with CLTI.
  • To identify risk factors, particularly focusing on CLTI severity, for adverse events.

Main Methods:

  • Retrospective analysis of 33 patients with CLTI who underwent cardiac surgery.
  • Classification of CLTI severity using the Wound, Ischemia, and foot Infection (WIfI) system (stages 1-2 vs. 3-4).

Main Results:

  • High-WIfI stage patients (3-4) had significantly higher in-hospital mortality (35% vs. 0%) and postoperative complication rates (70% vs. 23.1%) compared to low-WIfI stage patients (1-2).
  • Foot infection grade (WIfI) and low albumin levels were associated with postoperative complications.
  • 1- and 2-year survival rates were substantially lower in the high-WIfI group (45%/28.1%) versus the low-WIfI group (84.6%/67.7%).

Conclusions:

  • Cardiac surgery in patients with advanced CLTI (high WIfI stage) is associated with extremely high risk.
  • Consideration of pre-operative lower extremity revascularization or debridement to reduce WIfI stage may improve outcomes.
Abstract

Keywords:
WIfI classificationcardiac surgerychronic limb-threatening ischemia (CLTI)coronary artery deseasecritical limb ischaemia (CLI)peripheral artery disease (PAD)

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