Abstract
BackgroundCardiovascular events are the leading cause of perioperative complications among patients undergoing noncardiac surgery. However, the role of echocardiography for preoperative cardiac risk stratification prior to major noncardiac surgery is still controversial.MethodsThis retrospective study included a total of 1453 patients (51% male; age, 67 ± 16) who underwent intermediate- or high-risk major abdominal surgery or orthopedic surgery at two medical centers in South Taiwan between February 2013 and June 2016. All patients underwent preoperative transthoracic echocardiography (TTE). All of the included patients were followed up for 56 days after surgery. The primary endpoints were major adverse events (MAEs), i.e., all-cause mortality and major adverse cardiovascular-cerebral events (MACCEs).ResultsA total of 35 patients (2.4%) reached the primary endpoint: 24 patients (1.6%) died, and 17 patients (1.2%) had MACCEs. Patients with postsurgery MAEs had higher average E/e’ values, a lower Left ventricular (LV) ejection fraction, and higher prevalence of significant mitral regurgitation (MR) and moderate-advanced chronic kidney disease (CKD). Multivariate analysis showed that the modified Lee index and significant MR were independent prognostic predictors of MAEs.ConclusionPreoperative identification of significant MR on TTE is associated with increased MAEs at 56 days compared with that predicted by the modified Lee index alone in patients undergoing intermediate- or high-risk noncardiac surgery.
Highlights
Cardiovascular events are the leading cause of mortality among patients undergoing noncardiac surgery and depend on patient-related risk factors, the type of surgery, and the circumstances
Multivariate analysis showed that the modified Lee index and significant mitral regurgitation (MR) were independent prognostic predictors of major adverse events (MAE)
Preoperative identification of significant MR on Transthoracic echocardiography (TTE) is associated with increased MAEs at 56 days compared with that predicted by the modified Lee index alone in patients undergoing intermediate- or high-risk noncardiac surgery
Summary
Cardiovascular events are the leading cause of mortality among patients undergoing noncardiac surgery and depend on patient-related risk factors, the type of surgery, and the circumstances. 1–5% of cardiac events were reported in patients undergoing intermediate- or high-risk noncardiac surgery.[1] Transthoracic echocardiography (TTE) is a feasible and noninvasive technique used to evaluate cardiac structure and function. Several studies do not support the routine use of preoperative TTE for cardiac risk evaluation before major noncardiac surgery because echocardiographic measurements do not have better prognostic abilities than clinical risk factors.[2,3,4,5] On the other hand, some studies have demonstrated a positive correlation between a reduced Left ventricular (LV) ejection fraction (EF) and perioperative complications in patients undergoing major noncardiac surgeries.[6,7,8,9,10] We acknowledge that preoperative LV systolic function assessment is proven to predict perioperative outcome and long-term mortality in patients undergoing high-risk noncardiac surgery.[11] In real world practice, such as in Korea[12] or Taiwan, many surgeons and anesthesiologists have their own practical standards for requesting preoperative TTE prior to noncardiac surgery. The role of echocardiography for preoperative cardiac risk stratification prior to major noncardiac surgery is still controversial
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
