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The impact of a cardioprotective protocol on the incidence of cardiac complications after aortic abdominal surgery

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Published in Anesthesia and Analgesia. 2002, vol. 95, no. 6, p. 1525-33,tableofcontents
Abstract We analyzed a local database including 468 consecutive patients who underwent elective aortic abdominal surgery over an 8-yr period in a single institution. A new cardioprotective perioperative protocol was introduced in January 1997, and we questioned whether perioperative cardiac outcome could be favorably influenced by the application of a stepwise cardiovascular evaluation based on the American College of Cardiology/American Heart Association guidelines and by the use of antiadrenergic drugs. Clonidine was administered during surgery, and beta-blockers were titrated after surgery to achieve heart rates less than 80 bpm. We compared data of two consecutive 4-yr periods (1993-1996 [control period] versus 1997-2000 [intervention period]). Implementation of American College of Cardiology/American Heart Association guidelines was associated with increased preoperative myocardial scanning (44.3% vs 20.6%; P < 0.05) and coronary revascularization (7.7% vs 0.8%; P < 0.05). During the intervention period, there was a significant decrease in the incidence of cardiac complications (from 11.3% to 4.5%) and an increase in event-free survival at 1 yr after surgery (from 91.3% to 98.2%). Multivariate regression analysis showed that the combined administration of clonidine and beta-blockers was associated with a decreased risk of cardiovascular events (odds ratio, 0.3; 95% confidence interval, 0.1-0.8), whereas major bleeding, renal insufficiency, and chronic obstructive pulmonary disease were predictive of cardiac complications. In conclusion, cardiac testing was helpful to identify a small subset of high-risk patients who might benefit from coronary revascularization. Sequential and selective antiadrenergic treatments were associated with improved postoperative cardiac outcome.
Keywords Adrenergic beta-Antagonists/therapeutic useAgedAngioplasty, Balloon, CoronaryAorta, Abdominal/surgeryClonidine/therapeutic useCoronary Artery BypassCoronary Disease/epidemiology/prevention & controlFemaleHumansIncidenceMaleMiddle AgedMultivariate AnalysisPostoperative Complications/epidemiology/prevention & control
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PMID: 12456411
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Article (Published version) (400 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Structures
Research groups Chirurgie cardio-vasculaire (105)
Dysfonctions cardio-pulmonaires et cérébrales (278)
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LICKER, Marc et al. The impact of a cardioprotective protocol on the incidence of cardiac complications after aortic abdominal surgery. In: Anesthesia and Analgesia, 2002, vol. 95, n° 6, p. 1525-33,tableofcontents. https://archive-ouverte.unige.ch/unige:46202

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Deposited on : 2015-02-02

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