Is endovascular aortic aneurysm repair intermediate risk noncardiac surgery? A meta-analysis of cardiac morbidity reported in the randomised controlled trials comparing open and endovascular aortic aneurysm repair

Abstract

The American College of Cardiology (ACC) / American Heart Association (AHA) guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery has classified endovascular aortic aneurysm repair (EVAR) as intermediaterisk surgery. This guideline is not evidence-based. The aim of this study was to determine the incidence of major cardiac morbidity and mortality reported in the prospective randomised controlled trials of elective open abdominal aortic aneurysm (AAA) repair versus EVAR. By definition, intermediate surgery should have a combined incidence of 30-day cardiac death and nonfatal myocardial infarction of 1 to 5%, and major surgery should exceed 5%.