Related Experiment Videos
[Ischemic heart disease and postoperative mortality in major vascular surgery. An up-to-date diagnostic approach]
R Adovasio1, C Pandullo, A Nadal
1Istituto di Patologia Speciale Chirurgica, Università degli Studi, Trieste.
Insights
Dobutamine stress echocardiography effectively predicts perioperative cardiac risk in major vascular surgery patients. This safe, feasible, and reliable test aids in managing surgical and anesthetic care, improving patient outcomes.
Area of Science:
- Cardiology
- Vascular Surgery
- Echocardiography
Background:
- Major vascular surgery carries significant perioperative cardiac risks.
- Accurate prediction of cardiac risk is crucial for patient management.
- Dobutamine stress echocardiography (DSE) is a potential tool for risk stratification.
Purpose of the Study:
- To evaluate the efficacy of dobutamine stress echocardiography (DSE) in predicting perioperative cardiac risk.
- To assess the feasibility, safety, and reliability of DSE in patients undergoing major vascular surgery.
Main Methods:
- Seventy-seven patients undergoing major vascular surgery were assessed using transthoracic dobutamine stress echocardiography.
- Dobutamine was infused incrementally up to 40 mcg/kg/min, with atropine administered to augment heart rate.
- Electrocardiographic and echocardiographic monitoring identified ischemia and wall motion abnormalities.
Main Results:
- Twenty-six patients (33.8%) exhibited stress-induced ischemia on DSE.
- Three patients were deemed unsuitable for surgery due to poor cardiac conditions identified by DSE.
- Postoperatively, 4 cardiac ischemic complications and 2 deaths (2.5%) occurred among 73 surgically treated patients.
Conclusions:
- Dobutamine stress echocardiography is a feasible, safe, cost-effective, and reliable test for predicting perioperative cardiac risk.
- DSE findings informed surgical, anesthesiologic, and perioperative management decisions.
- The study supports the utility of DSE in optimizing patient care for major vascular surgery.
Background:
The aim of this study is to evaluate the efficacy the dobutamine stress echocardiography in predicting the perioperative cardiac risk of patients undergoing major vascular surgery.
Methods:
Seventy-seven consecutive and not selected patients, undergoing a surgical treatment requiring aortic cross clamping, were assessed also with a transthoracic dobutamine stress echocardiography. With electrocardiographic and echocardiographic monitoring ventricular ischemia or wall motion abnormalities, 5 micrograms/kg per min of chlorhydrate dobutamine for 5 minutes were infused, followed by other 10 micrograms/kg per min increased up to 40 micrograms/kg per min. During the last 4 minutes 0.25 mg of atropin were infused increasingly up to 1 mg.
Results:
Of all these patients, 26 had a stress ischemia but only 4 cases underwent a coronary angiography and only 2 of these underwent a preventive myocardial revascularization. Due to poor cardiac conditions pointed out with the dobutamine stress, 3 patients were not treated surgically. With an aggressive intra- and perioperative monitoring 73 patients underwent a surgical treatment: they were 28 aorto-bifemoral, 3 aorto-aortic grafts, 1 aorto-bisiliac thoraco-abdominal interposition graft, and 20 aorto-bifemoral, 4 aorto-femoral, 1 aorto-aortic thoraco-abdominal, 1 aorto-renal by-pass and 7 aorto-iliac-femoral thromboendoarterectomies. In the postoperative period 4 cardiac ischemic complications and 2 deaths (2.5%) were observed.
Conclusions:
According to our personal opinion, stress echocardiography can be considered a test with a excellent feasibility and safety rate, not expensive and with a good reproducibility and reliability. It allowed to predict the cardiac risk in our patients suggesting not only the surgical but also the anesthesiologic and the perioperative therapeutic management.