Role of Cardiac Evaluation Before Thoracic Endovascular Aortic Repair | Journal Scan

Jan 30, 2015
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Authors:
Ganapathi AM, Englum BR, Schechter MA, et al.
Citation:
J Vasc Surg 2014;60:1196-1203.
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

What is the incidence of adverse cardiovascular events following thoracic endovascular aortic repair (TEVAR), and what is the efficacy of a limited preoperative cardiovascular evaluation before TEVAR?

Methods:

This was a retrospective review of all patients undergoing TEVAR between May 2002 and June 2013 at a single referral institution. Patients were categorized into the following groups on the basis of the degree of preoperative cardiac evaluation that was performed: no workup, resting electrocardiogram (ECG), resting transthoracic echocardiogram (TTE), exercise/pharmacologic stress testing, and coronary angiography. The primary study endpoint was the incidence of a perioperative myocardial infarction or cardiac arrest.

Results:

The analytic sample included 343 patients, who underwent the following preoperative cardiovascular evaluation: 28 patients (7.3%), no cardiac workup; 127 patients (33.4%), ECG alone; 208 patients (54.7%), TTE; 12 patients (3.2%), stress test; and 5 patients (1.3%), coronary angiography. Nine patients (2.4%) experienced the primary endpoint and there was no significant difference among groups (p = 0.45).

Conclusions:

In a retrospective review of patients undergoing TEVAR at a single institution, the risk of a perioperative myocardial infarction or cardiac arrest was low, and there were no differences in outcomes among patients with different intensities of preoperative evaluation.

Perspective:

This is an interesting study that establishes the relatively low incidence of postoperative cardiac events following TEVAR. While this observation is reassuring, the limitations of the study should be kept in mind, including the retrospective study design, small cohort, and small number of events (9 or 2.4%). That said, the authors’ observations reinforce the current practice of limiting noninvasive stress testing in the perioperative period to populations who have an indication for such testing independent of the planned surgery or procedure.

Keywords: Aorta, Thoracic, Coronary Angiography, Electrocardiography, Exercise Test, Heart Arrest, Myocardial Infarction, Perioperative Period, Retrospective Studies, Incidence, Thoracic Surgery


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