Randomized study comparing cardiac response in endovascular and open abdominal aortic aneurysm repair

Background: The aim was to compare the cardiac response and the incidence o f adverse cardiac events during and after endovascular (EVAR) and open (OR) repair of abdominal aortic aneurysms (AAAs). Methods: Seventy-six patients with an AAA suitable for EVAR, and in a gener al condition allowing open surgery were randomized to EVAR (57 patients) or OR (19 patients). The analysis was on an intention-to-treat basis. Haemody namic variables were assessed intraoperatively before, during and after aor tic occlusion. During the procedure myocardial ischaemia was identified wit h use of electrocardiography (ECG) and transoesophageal echocardiography (T EE). After operation, cardiac complications were diagnosed by clinical obse rvation, 12-lead ECG at 1 h, 1 day and 7 days, echocardiography at 1 month and measurement of cardiac enzymes. Results: After aortic occlusion, a greater decrease in systemic vascular re sistance compared with baseline was observed with OR than with EVAR (- 396 and - 70 dyne s/cm(5) respectively; P = 0.03). The stroke work index, as a direct measure of myocardial performance, demonstrated a decrease during OR and an increase during EVAR during aortic occlusion (- 6.6 and + 1.7 g m/m (2) respectively; P = 0.03) as well as after aortic occlusion (- 7.6 and 3.4 g m/m(2) respectively; P < 0.01), compared with baseline. The incidence of postoperative clinical cardiac complications was comparable in the two study groups; however, myocardial ischaemia, as observed by ECG and TEE, wa s observed more frequently in the OR group (ten of 19 versus 15 of 57 patie nts; P = 0.05). Conclusion: Haemodynamic changes were less severe and there was a lower inc idence of myocardial ischaemia during EVAR than during OR. Studies are need ed to demonstrate whether this may reduce the operative mortality rate.