Cardiopulmonary exercise testing for preoperative risk assessment before hepatic resection

Abstract

CPET provides a useful prognostic adjunct in the preoperative assessment of patients undergoing hepatic resection.

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

“…In a single, tertiary-center study, patients with moderate AS (aortic valve area: 1.0 cm 2 to 1.5 cm 2 ) or severe AS (aortic valve area <1.0 cm 2 ) undergoing nonemergency noncardiac surgery had a 30-day mortality rate of 2.1%, compared with 1.0% in propensity score-matched patients without AS (P=0.036). 75 Postoperative MI was more frequent in patients with AS than in patients without AS (3.0% versus 1.1%; P=0.001). Patients with AS had worse primary outcomes (defined as composite of 30-day mortality and postoperative MI) than did patients without AS (4.4% versus 1.7%; P=0.002 for patients with moderate AS; 5.7% versus 2.7%; P=0.02 for patients with severe AS).…”

Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention

“…AT represents the upper limit of workload beyond which prolonged exercise is impossible (28). It has been shown to be an objective marker of CVR (19)(20)(21)(22)28). Patients undergoing EVAR have a high-prevalence of AKI risk-factors and are at significant risk of AKI (1,14).…”

“…Cardiovascular reserve (CVR) is a parameter that is modifiable through various interventions before non-urgent surgery. Estimation of CVR is increasingly being used to identify those at highest risk of complications after surgery (19)(20)(21)(22).…”

“…The corresponding VO2 at which circulating lactate begins to rise defines the point of Anaerobic Threshold (AT), which can be measured by Cardiopulmonary Exercise Testing (CPET). The latter (CPET) is now being used frequently prior to major surgery (20)(21)(22)(23)(24). It provides an accurate estimate of CVR by measuring AT, a validated objective and reproducible marker of CVR, independent patient effort (25)(26)(27)(28)(29).…”

Cardiopulmonary Exercise Testing for Risk Prediction in Major Abdominal Surgery

“…In most studies, both AT and _ V O 2 peak were associated with outcome, although this association was statistically stronger for the AT in most cases (see Table 2). Abnormal ventilatory equivalents for carbon dioxide reflecting increased dead space were also associated with both mortality and morbidity in some case series, 52,73,74 but not in others. 70,75 The AT threshold of 11 mL/kg/min to identify high-risk patients initially proposed by Older 69 was based on criteria used for the diagnosis of heart failure.…”