Cardiac response and complications during endovascular repair of abdominalaortic aneurysms: A concurrent comparison with open surgery

Purpose: The purpose of this study was to assess and to compare perioperati ve changes in left ventricular function and the incidence of adverse cardia c events in two groups of patients with abdominal aortic aneurysms, one dur ing endovascular aneurysm repair (EAR) and the other during open aneurysm r epair (OAR). Methods: One hundred twenty consecutive patients who underwent EAR (49 pati ents) or OAR (71 patients) were prospectively studied. During the operation , the left ventricular function was assessed by the recording of the left v entricle stroke work index (SWI) and the cardiac index (CI) with a pulmonar y artery catheter. Measurements were performed before, during, and after st ent-graft deployment or aortic cross-clamping. Both maneuvers were defined as aortic occlusion (AO). Transesophageal echocardiography was performed to identify signs of wail motion abnormalities of the left ventricular wall, which indicated myocardial ischemia. Six-lead electrocardiograph monitoring was maintained until discharge from the intensive care unit. Postoperative cardiac complications were diagnosed by clinical observation, 12-lead ECG analysis at 1, 3, and 7 days after the operation, transthoracic echocardiog raphy at 1 month, and measurement of cardiac enzymes. Results: The two study groups were comparable with regard to most clinical aspects. The baseline myocardial performance was worse in patients who unde rwent EAR compared with patients who underwent OAR, as indicated by a reduc ed SWI (33.1 and 37.4, respectively; P = .03). During AO there was a compar able increase of the CI in both groups. However, after AO the rise in CI wa s higher in patients who underwent OAR compared with patients who underwent EAR (0.7 and 0.2, respectively; P < .01), representing a more pronounced h yperdynamic state. In addition, the SWI demonstrated a decrease in patients who underwent OAR compared with an increase in patients who underwent EAR during AO (-1.4 and +1.9, respectively; P = .04) and after AO (-0.9 and +2. 6, respectively; P = .01). These findings represent more severe myocardial stress in patients who underwent OAR. The incidence of postoperative clinic al cardiac adverse events was comparable in the two study groups. However, myocardial ischemia, as indicated by electrocardiography and transesophagea l echocardiography, had a higher incidence in patients who underwent open s urgery as compared with patients whose condition was managed endovascularly (57% and 33%, respectively; P = .01). Conclusion: Hemodynamic alterations during endovascular repair were not as severe as those in patients with open surgery and indicated less myocardial stress in the former category. These findings may explain a lower incidenc e of myocardial ischemia that was observed during endovascular repair. A lo wer frequency of clinical perioperative cardiac events in patients undergoi ng endovascular treatment may ultimately be expected.