Preoperative cardiac evaluation in patients undergoing major vascular surgery

Aim: Aim of this study was to evaluate the effectiveness of a standardized preoperative cardiac assessment in the reduction of perioperative cardiac risk in patients undergoing major vascular surgery. Methods: From January to December 2006, 703 elective interventions for major vascular diseases (carotid stenosis, CS; abdominal aortic aneurysm, AAA; peripheral arterial obstructive disease, PAOD) were performed; 527 of these patients underwent preoperative diagnostic assessment in an outpatient basis at the Vascular Surgery Department. All these patients underwent preoperative standardized diagnostic and cardiac assessment in order to evaluate the perioperative cardiac risk. A surgical (open or endovascular) intervention was performed to all patients and perioperative (<30 days) results in terms of overall and cardiac mortality and morbidity rates were recorded. Results: Patients suffered from a CS in 283 cases (53.7%), an AAA in 144 cases (27.3%) and a PAOD in 100 cases (19%). In all the cases electrocardiogram, cardiac consultation, and echocardiography were performed. One-hundred-ninety-two patients (36.4%) underwent further evaluation of cardiac functional capacity with a non-invasive stress testing and in 19 patients a coronary angiography was performed; nine of these were successfully treated (8 percutaneous transluminal coronary angioplasty, PTCA, e 1 coronary artery bypass graft, CABG) prior to vascular surgery. Thirty-day overall and cardiac mortality rates were 0.6% and 0.4%, respectively. Patients with AAA had a higher risk of 30-day overall mortality; in this subgroup, hypercholesterolemia, chronic renal failure, valvular heart disease and history of previous congestive heart failure represented factors significantly affecting 30-day cardiac mortality. Thirty-day overall and cardiac morbidity rates were 6.4% and 4.4%, respectively. Patients with AAA showed an increased risk of overall and cardiac 30-day morbidity rates; chronic renal failure significantly affected 30-day cardiac morbidity. A positive preoperative non-invasive stress testing does not affect 30-day overall and cardiac morbidity and mortality rates. Conclusion: In this study, the use of an accurate preoperative cardiac assessment including selective non-invasive stress testing allowed surgeons to obtain satisfactory perioperative results in patients undergoing major vascular surgery. Routine preoperative evaluation with non-invasive stress testing does not seem to improve perioperative cardiac results in any subgroups of treated vascular diseases.