Clinical implications of preoperative echocardiographic findings on cardiovascular outcomes following vascular surgery: An observational trial.

Autor: Meyer MJ; Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America., Jameson SA; Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America., Gillig EJ; Department of Anesthesiology, Newton Wellesley Hospital, Newton, MA, United States of America., Aggarwal A; Department of Surgery, Franciscan Physicians Network Vascular Surgeons, Indianapolis, IN, United States of America., Ratcliffe SJ; Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States of America., Baldwin M; Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States of America., Singh KE; Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America., Clouse WD; Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States of America., Blank RS; Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Jan 19; Vol. 18 (1), pp. e0280531. Date of Electronic Publication: 2023 Jan 19 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0280531
Abstrakt: Introduction: Peripheral artery disease and cardiac disease are often comorbid conditions. Echocardiography is a diagnostic tool that can be performed preoperatively to risk stratify patients by a functional cardiac test. We hypothesized that ventricular dysfunction and valvular lesions were associated with an increased incidence of expanded major adverse cardiac events (Expanded MACE).
Methods and Materials: Retrospective cohort study from 2011 to 2020 including all patients from a major academic center who had vascular surgery and an echocardiographic study within two years of the index procedure.
Results: 813 patients were included in the study; a majority had a history of smoking (86%), an ASA score of 3 (65%), and were male (68%). Carotid endarterectomy was the most common surgery (24%) and the least common surgery was open abdominal aortic aneurysm repair (5%). We found no significant association between the echocardiographic findings of left ventricular dysfunction, right ventricular dysfunction, or valvular lesions and the postoperative development of Expanded MACE.
Conclusions: The preoperative echocardiographic findings of left ventricular dysfunction, right ventricular dysfunction and moderate to severe valvular lesions were not predictive of an increased incidence of postoperative Expanded MACE. We identified a significant association between RV dysfunction and post-operative dialysis that should be interpreted carefully due to the small number of outcomes. The transition from open to endovascular surgery and advances in perioperative management may have led to improved cardiovascular outcomes.
Trial Registration: Trial Registration: NCT04836702 (clinicaltrials.gov). https://www.google.com/search?client=firefox-b-d&q=NCT04836702.
Competing Interests: The authors acknowledge no competing interest related to this manuscript. MJM has patent applications related to perioperative efficiency (wireless suture needles, scrub table item usage analysis), ownership of PeriOp Green Inc., consulted with Dialectica on viscoelastic monitoring of blood clotting, spoke at Takeda Pharmaceutical on sustainability in healthcare. RSB receives a royalty for publication in UpToDate from Wolters-Kluwer.
(Copyright: © 2023 Meyer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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