Abstract
Background: Abdominal aortic aneurysm (AAA) and cardiovascular disease are intimately associated, the latter representing the most common cause of death in Sweden. Cardiac complications are held responsible for the majority of perioperative morbidity and mortality in patients undergoing repair of AAA. The importance of preoperative thorough cardiac assessment is therefore obvious. The aim of this study was to evaluate the prognostic significance of preoperative echocardiographic findings for 1-year mortality after elective endovascular aneurysm repair (EVAR) of infrarenal AAA. Design: Retrospective analysis. Methods: The 505 patients were identified in a prospective database for endovascular interventions between 1998 and 2011, and data were retrieved from patient records. Preoperative echocardiography reports in 380 patients were reviewed and findings were notified according to a predefined protocol. Results: The 1-year mortality rate was 6.7%. Severe valve disease was present in 8.7% of the patients, aortic valve stenosis being the leading cause of valve pathology. Severe valve disease (OR 3.5, 95% CI [1.2 - 10.7]; p = 0.025) and chronic kidney disease grade ≥ 3 (OR 7.5, 95% CI [2.1 - 26.1]; p = 0.002) were the only independent risk factors for increased mortality rate at 1-year. Conclusion: Echocardiography should be a part of the preoperative workup in AAA patients. Finding of severe valve disease should be further evaluated by a cardiologist prior to EVAR.
Highlights
Abdominal aortic aneurysm (AAA) may be considered as one of many end-stage manifestations of atherosclerotic cardiovascular disease and it is the most common cause of death in Sweden [1]
The most important finding of the present study was that patients with severe valve disease undergoing elective standard infrarenal endovascular aneurysm repair (EVAR) for AAA had, after multivariable testing, an increased risk of mortality at 1-year follow-up
In a previous report [3], the presence of a valvular heart disease and a positive dobutamine stress echocardiography were found to be the only factors that were independently associated with increased 30-day cardiovascular morbidity after EVAR and open repair of AAA
Summary
Abdominal aortic aneurysm (AAA) may be considered as one of many end-stage manifestations of atherosclerotic cardiovascular disease and it is the most common cause of death in Sweden [1]. Echocardiography has been a standard tool for preoperative cardiac assessment prior to endovascular repair (EVAR) for AAA in our and other institutions. The aim of this study was to evaluate the prognostic value of preoperative echocardiographic findings for 1-year mortality after standard infrarenal EVAR. Abdominal aortic aneurysm (AAA) and cardiovascular disease are intimately associated, the latter representing the most common cause of death in Sweden. The aim of this study was to evaluate the prognostic significance of preoperative echocardiographic findings for 1-year mortality after elective endovascular aneurysm repair (EVAR) of infrarenal AAA. Finding of severe valve disease should be further evaluated by a cardiologist prior to EVAR
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