Risk of aortic aneurysm surgery as assessed by preoperative gated heart pool scan

Abstract

Gated heart pool scan measuring left ventricular ejection fraction (LVEF) was performed preoperatively in 72 patients presenting for elective repair of abdominal aortic aneurysm. Patients with a positive cardiac history were more likely to have a LVEF of less than or equal to 45 per cent (P less than 0.001). The operative mortality rate was 4 per cent. Each of three patients who died had a LVEF less than or equal to 35 per cent and developed cardiac failure which led to renal failure. Five other patients developed cardiac failure manifested by acute pulmonary oedema during the early postoperative period. There was no statistically significant association between a positive cardiac history and the occurrence of postoperative cardiac failure or death. However, patients with a LVEF of less than or equal to 45 per cent were more likely to develop postoperative cardiac failure (P = 0.004) while patients with a LVEF of less than or equal to 35 per cent had a greater chance of dying (P less than 0.001). No patient died with a LVEF greater than 35 per cent. Preoperative evaluation of LVEF can select patients at high risk of cardiac death from repair of abdominal aortic aneurysm. Such patients could be followed conservatively if they remain asymptomatic and the aneurysm does not enlarge. If operation is considered mandatory, patients with a low LVEF should receive intensive perioperative monitoring with enhancement of ventricular performance.

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…Resting LV function has been evaluated before noncardiac surgery by radionuclide angiography, echocardiography, and contrast ventriculography. 46,[151][152][153][154][155][156][157][158][159][160] Of 9 studies that demonstrated a positive relation between decreased preoperative ejection fraction and postoperative mortality or morbidity, 6 were prospective, 151,152,155,158,161,162 and 3 were retrospective. 153,154,158 Halm et al 161 studied a cohort of 339 men either with documented ischemic heart disease or multiple risk factors for CHD; 49% had clinically evident vascular disease.…”

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…Therefore, the physician must exercise judgment to correctly assess perioperative surgical risks and the need for further evaluation. Resting LV function has been evaluated before noncardiac surgery by radionuclide angiography, echocardiography, and contrast ventriculography (46,(151)(152)(153)(154)(155)(156)(157)(158)(159)(160). Of 9 studies that demonstrated a positive relation between decreased preoperative ejection fraction and postoperative mortality or morbidity, 6 were prospective (151,152,155,158,161,162), and 3 were retrospective (153,154,158).…”

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…Resting LV function has been evaluated before noncardiac surgery by radionuclide angiography, echocardiography, and contrast ventriculography (46,(151)(152)(153)(154)(155)(156)(157)(158)(159)(160). Of 9 studies that demonstrated a positive relation between decreased preoperative ejection fraction and postoperative mortality or morbidity, 7 were prospective (151,152,154,155,158,161,162), and 2 were retrospective (153,156). Halm et al (161) studied a cohort of 339 men either with documented ischemic heart disease or multiple risk factors for CHD; 49% had clinically evident vascular disease.…”