Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing

Carlisle, J. B.; Swart, M.

doi:10.1002/bjs.5734

Cited by 190 publications

(55 citation statements)

References 20 publications

(13 reference statements)

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“…A V  E/V  CO2, threshold of 41 as a predictor of postoperative and long-term survival is similar to the findings of Carlisle and colleagues, reporting V  E/V  CO2 above 42 as the strongest predictor of 30 day and mid-term survival following elective abdominal aortic aneurysm repair [22].…”

Section: Discussionsupporting

confidence: 87%

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Cardiopulmonary Exercise Testing for Preoperative Risk Assessment before Pancreaticoduodenectomy for Cancer

et al. 2014

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2014) 'Cardiopulmonary exercise testing for preoperative risk assessment before pancreaticoduodenectomy for cancer.', Annals of surgical oncology., 21 (6). pp. 1929-1936. Further information on publisher's website:http://dx.doi.org/10.1245/s10434-014-3493-0Publisher's copyright statement:The nal publication is available at Springer via http://dx.doi.org/10.1245/s10434-014-3493-0.Additional information: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. predicted poor long-term survival (HR 2.05, 95% CI: 1.09 to 3.86, p=0.026). Conclusions:CPET is a useful adjunctive test for predicting post-operative outcome in patients being assessed for pancreaticoduodenectomy. Raised CPET-derivedV  E/V  CO2 predicts early post-operative death and poor long-term survival.[Word count 238].

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Section: Discussionsupporting

confidence: 87%

“…The reason for this is that CPET data from other studies indicates that the validity of this test is maximal in assessing high-risk patients [22] but it should be acknowledged that if the test had been applied to all patients different results may have been obtained.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Exercise Testing for Preoperative Risk Assessment before Pancreaticoduodenectomy for Cancer

et al. 2014

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“…Abdominal aortic aneurysm repair Carlisle et al [35] [41] recorded the _ VO 2 peak of 30 patients prior to elective AAA repair and followed them up postoperatively for 12 months. He found no significant difference in the _ VO 2 peak in those who had postoperative complications compared to those who did not, though there was an underlying trend with 70% of the patients with complications having a _ VO 2 peak of < 20 ml.min .kg )1 as opposed to 50% in the non-complication group.…”

Section: Resultsmentioning

confidence: 99%

Cardiopulmonary exercise testing as a risk assessment method in non cardio‐pulmonary surgery: a systematic review

Smith¹,

Stonell

Purkayastha³

et al. 2009

Anaesthesia

199

146

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SummaryThis study reviews the predictive value of maximum oxygen consumption ( _ VO 2 max ) and anaerobic threshold, obtained through cardiopulmonary exercise testing, in calculating peri-operative morbidity and mortality in non-cardiopulmonary thoraco-abdominal surgery. A literature review provided nine studies that investigated either one or both of these two variables across a wide range of surgical procedures. Six of the seven studies that reported sufficiently detailed results on peak oxygen consumption and four of the six studies that reported sufficiently detailed results on anaerobic threshold found them to be significant predictors. We conclude that peak oxygen consumption and possibly anaerobic threshold are valid predictors of peri-operative morbidity and mortality in non-cardiopulmonary thoraco-abdominal surgery. These indicators could potentially provide a means of allocating increased care to high-risk patients. Cardiopulmonary exercise testing (CPET or CPX) is a non-invasive, integrated assessment of cardiovascular and pulmonary function both at rest and under stress. Among the purported benefits is its ability to determine the ability of the subject's physiological capacity to cope with the metabolic demands created by the trauma of major surgery. During the test subjects are exposed to incremental physical exercise up to their maximally tolerated level, dictated either by exhaustion or symptom related cessation (e.g., breathlessness or angina). Several physiological variables are recorded including ventilatory parameters, inspiratory and expiratory gases, blood pressure (BP) and electrocardiogram (ECG). From these are derived two key indicators: the body's maximum oxygen uptake ( _ VO 2 max ) and the point at which anaerobic metabolism exceeds aerobic metabolism (Ventilatory Anaerobic Threshold or VAT). Together, these broadly indicate the ability of the cardiovascular system to deliver oxygen to the peripheral tissues and the ability of the tissues to utilise that oxygen. It has already been demonstrated that measures such as _ VO 2 max are useful predictors of postoperative complications of pulmonary resection surgery [1][2][3] and assessing the timing of cardiac transplant surgery [4], while the VAT is a predictor of postoperative cardiac complications in abdominal surgery [5]. Physiology of the anaerobic thresholdLactate accumulation in exercising muscle occurs when the muscle O 2 demand exceeds the supply. At this point the venous lactate concentration will begin to rise. This point is called the Lactate Anaerobic Threshold (LAT). The muscle lactate ⁄ pyruvate ratio increases at the LAT which supports the concept that the lactic acidosis results from relative muscle hypoxia [6][7][8].As an individual commences an incremental exercise test, their expired minute volume ( _ V E ), oxygen consumption per minute ( _ VO 2 ) and CO 2 production per minute ( _ VCO 2 ) all increase linearly with respect to variables such as work rate or time. However a point is reached when _ VCO 2 increases out of ...

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“…Recent studies suggest that in addition to being a strong predictor of cardiovascular and all-cause mortality in both asymptomatic and clinically referred populations, CRF could be especially helpful in the preoperative risk assessment of patients undergoing cardiovascular and noncardiovascular surgery, 58 predicting surgical complications and short-term outcomes in patients subjected to abdominal aortic aneurysm repair, [59][60][61] hepatic transplantation, 62,63 lung cancer resection, 64 upper gastrointestinal surgery, 65,66 intra-abdominal surgery, 67,68 bariatric surgery, 69 and coronary artery bypass grafting. 70 In addition, when patients with coronary artery disease who had to wait in the hospital for coronary artery bypass grafting were randomized into an exercise training group, outcomes were superior to those in the standard care group, because a reduced rate of postoperative complications and shorter hospital stays were observed (Table 2).…”

Section: Crf As a Preoperative Predictor Of Surgical Riskmentioning

confidence: 99%

Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association

Ross¹,

Blair²,

Arena³

et al. 2016

Circulation

1,579

1,697

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ABSTRACT:Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association's 2020 goals.M ounting evidence over the past 3 decades has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease (CVD) and all-cause mortality, as well as mortality rates attributable to various cancers, especially of the breast and colon/digestive tract. [1][2][3][4] Importantly, improvements in CRF are associated with reduced mortality risk.5 Although CRF is now recognized as an important marker of cardiovascular health, it is currently the only major risk factor not routinely assessed in clinical practice.In 2013, the American Heart Association and the American College of Cardiology jointly released new guidelines for the prevention and treatment of coronary artery disease.6 Although CRF is the fourth-leading risk factor for CVD and has long been established as a significant prognostic marker, 7 it was excluded from the risk calculator. The authors of the guidelines noted that the evidence that CRF would enhance risk classification was inconclusive, and thus, the added contribution of CRF to determine CVD risk was uncertain. There is, however, a large body of epidemiological and clinical evidence demonstrating not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus (T2DM), but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes.

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Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing

Abstract: Preoperative CPX testing, combined with simple co-morbidity scoring, identified patients unlikely to survive in the mid-term, even after successful AAA repair.

Cited by 190 publications

References 20 publications

Cardiopulmonary Exercise Testing for Preoperative Risk Assessment before Pancreaticoduodenectomy for Cancer

Cardiopulmonary Exercise Testing for Preoperative Risk Assessment before Pancreaticoduodenectomy for Cancer

Cardiopulmonary exercise testing as a risk assessment method in non cardio‐pulmonary surgery: a systematic review

Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association

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