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Does Adult Spinal Deformity Affect Cardiac Function? A Prospective Perioperative Study
Yuki Mihara1,2, Takeji Saitoh3, Tomohiko Hasegawa1
1Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan.
Insights
Adult spinal deformity surgery did not worsen cardiac function. Patients with lower preoperative cardiac function showed significant improvements after surgery, with specific correlations found between cardiac metrics and spinal alignment.
Area of Science:
- Cardiology
- Orthopedic Surgery
- Spinal Deformity Correction
Background:
- Adult spinal deformity (ASD) surgery rates are increasing, particularly in older adults.
- High rates of perioperative complications, including cardiopulmonary issues, persist in ASD surgery.
Purpose of the Study:
- To investigate perioperative cardiac function in patients undergoing adult spinal deformity surgery.
- To assess changes in left and right ventricular contractility using echocardiography.
- To correlate cardiac function with spinopelvic radiographic parameters.
Main Methods:
- Prospective comparative study of 61 ASD patients (May 2016-April 2018).
- Echocardiography (preoperative and 2 weeks postoperative) measured LVEF, TAPSE, and S'.
- Radiographic parameters including thoracic kyphosis, lumbar lordosis, and inflection point were analyzed.
Main Results:
- Overall cardiac function (LVEF, TAPSE, S') showed no significant change postoperatively.
- Patients with lower preoperative cardiac function (LVEF<59.3%, TAPSE<17mm, S'<11.8cm/s) demonstrated significant improvements.
- Lower preoperative inflection point correlated with lower LVEF; larger thoracic kyphosis correlated with lower S'.
Conclusions:
- Adult spinal deformity surgery does not lead to perioperative cardiac function deterioration.
- Patients with initially lower cardiac function experience significant postoperative improvements.
- Preoperative spinal alignment parameters are associated with baseline cardiac function.
Study Design:
Prospective comparative study.
Objective:
The objective of this study was to investigate perioperative cardiac function using echocardiography in patients undergoing surgery for the adult spinal deformity (ASD).
Summary Of Background Data:
Corrective surgery for ASD has increased, especially in older persons. However, perioperative complication rates remain high in ASD surgery, including cardiopulmonary complications.
Materials And Methods:
This study included patients with ASD who underwent surgery between May 2016 and April 2018. A cardiologist performed all echocardiography imaging preoperatively and 2 weeks postoperatively. Left ventricular contractility was measured using left ventricular ejection fraction (LVEF), and right ventricular contractility was measured using tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (S'). Spinopelvic radiographic parameters, the apices of thoracic kyphosis and lumbar lordosis, and the inflection point where the vertebral curvature changes from kyphosis to lordosis were also measured. Differences between preoperative and postoperative measurements for continuous variables were analyzed using a paired Student t test. Differences in continuous and categorical variables between two independent groups were analyzed using an unpaired Student t test and Fisher exact test, respectively. Multivariate logistic regression analyses were performed to detect influential factors.
Results:
Sixty-one patients were included [12 males and 49 females; average age, 64.0 (22-84) yr]. LVEF, TAPSE, and S', respectively changed from 64.4%, 24.9 mm, and 14.3 cm/s to 65.4%, 25 mm, and 15 cm/s postoperatively with no significance. However, in LVEF<59.3% (average-1 SD), TAPSE<17 mm, and S'<11.8 cm/s cases, respectively, these increased significantly from 55.7%, 17.9 mm, and 10.5 cm/s to 60.9%, 21.4 mm, and 14.2 cm/s postoperatively ( P =0.036, 0.029, and 0.022, respectively). The LVEF<59.3% group showed a significantly lower inflection point level (1.5 vs. 2.9) preoperatively ( P =0.007). The S'<11.8 cm/s group showed significantly larger thoracic kyphosis (28.3° vs. 19.4°) preoperatively ( P =0.013).
Conclusions:
Perioperative cardiac function did not deteriorate after surgery in patients with ASD. In those with lower cardiac function preoperatively, there were significant improvements noted postoperatively. The preoperative inflection point level was significantly lower in the lower LVEF group. Preoperative thoracic kyphosis was significantly larger in the lower tricuspid annular peak systolic velocity group.
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