Influence of respiratory disease on perioperative cardiac risk in patientsundergoing elective surgery for abdominal aortic aneurysm

We retrospectively reviewed perioperative cardiac complications in a series of 214 patients who underwent surgical treatment for infrarenal aortic ane urysm between 1992 and 1996. There were 192 men and 22 women, with a mean a ge of 68.3 years. Cardiac risk factors included angina in 28% of patients a nd previous myocardial infarction in 25%. Resting electrocardiography was n ormal in 80 patients (37.5%). Depending on clinical findings, thallium-201 scintigraphy was undertaken in 76 patients (35.5%) and led to elective coro nary arteriography in 22 patients (10%). Results of coronary arteriography revealed lesions in 14 patients. Aortic reconstruction was performed by the transperitoneal route in all patients. Procedures consisted of aortoaortic bypass (63%), aortobiiliac bypass (27.5%), or aortobifemoral bypass (9.5%) . Nine patients (4.2%) died within the first 30 postoperative days. The cau se of death was myocardial infarction (MI) in two patients (1%), colonic ne crosis in two (1%), acute pancreatitis in one (0.5%), acute renal insuffici ency in three (1.4%), and multiple organ failure in one patient (0.5%). Non fatal cardiac complications were observed in 15 patients (7%). Statistical analysis of risk factors revealed two predictors of perioperative cardiac c omplications, i.e., history of chronic bronchitis and reoperation. On revie w of the literature, we cannot propose a routine preoperative work-up. Pros pective multicentric studies are needed to determine the predictive value o f current preoperative screening methods. DOI: 10.1007/s100169910060.