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Morbidity and mortality after abdominal aortic surgery in a population of patients with high cardiovascular risk
1Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Insights
Postoperative myocardial infarction is a significant risk following abdominal aortic surgery. Preoperative cardiac assessment and intervention, particularly for patients with aortic aneurysms and prior myocardial infarction, can reduce mortality.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Surgery
Background:
- Postoperative myocardial infarction (PMI) is a significant risk in patients undergoing abdominal aortic surgery.
- Abdominal aortic surgery, including aortic aneurysm repair and aortobifemoral grafting, carries substantial cardiovascular risks.
- Patients in areas with limited access to cardiac surgery may have higher rates of uncorrected ischemic heart disease.
Purpose of the Study:
- To review the morbidity and mortality associated with abdominal aortic surgery in a tertiary referral center.
- To identify the primary causes of death, particularly focusing on postoperative myocardial infarction (PMI) and multiorgan failure.
- To evaluate the impact of preoperative ischemic heart disease on surgical outcomes.
Main Methods:
- Retrospective review of 639 consecutive patients undergoing abdominal aortic surgery (aortic aneurysm repair or aortobifemoral grafting).
- Data collected included patient demographics, surgical procedure, preoperative cardiac status, and in-hospital outcomes (morbidity and mortality).
- Analysis of causes of death, with specific attention to PMI and multiorgan failure.
Main Results:
- Hospital mortality was 29% for ruptured aortic aneurysms (n=101), with PMI (31%) and multiorgan failure (48%) as leading causes of death.
- Mortality was 9% for intact aortic aneurysms (n=253), with PMI being the major cause of death (62%), often linked to uncorrected preoperative ischemic heart disease.
- Aortobifemoral grafting (n=285) had a lower mortality of 3%, despite a high incidence of preoperative ischemic heart disease.
Conclusions:
- Postoperative myocardial infarction is a critical determinant of mortality in abdominal aortic surgery, especially in ruptured aneurysms.
- Improved preoperative cardiac screening and intervention, including coronary artery bypass grafting, are crucial for patients with aortic aneurysms and a history of myocardial infarction.
- Enhanced screening for aortic aneurysms before rupture is essential to reduce mortality from ruptured aortic aneurysms.
Abstract:
Postoperative myocardial infarction is a major risk factor in patients undergoing abdominal aortic surgery. Correction of cardiac ischaemia prior to abdominal aortic surgery improves outcome. The morbidity and mortality of 639 consecutive patients were reviewed from an area with poor access to cardiac surgery, operated upon in a single tertiary referral hospital for aortic aneurysm or aortobifemoral grafting. A total of 101 patients with ruptured aortic aneurysm who survived to reach the intensive care unit experienced a hospital mortality of 29%. Multiorgan failure was the cause of death in 48% and postoperative myocardial infarction in 31%. Of the 253 patients with intact aortic aneurysm, which included elective and urgent resection, the mortality was 9%. There was a high incidence of uncorrected pre-operative ischaemic heart disease and myocardial infarction was the major cause of death (62%). Pre-operative myocardial infarction was predictive of postoperative cardiac morbidity and mortality. Of the 285 patients undergoing aortobifemoral grafting the mortality was 3% despite a high incidence of pre-operative ischaemic heart disease. Further reductions in postoperative death from ruptured aortic aneurysm must await improved screening to diagnose and treat the aneurysm before rupture. In patients operated upon electively, improved pre-operative cardiac screening and coronary bypass grafting where appropriate, especially for patients with aortic aneurysm and previous myocardial infarction, may further reduce peri-operative mortality.