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Title

The impact of a cardioprotective protocol on the incidence of cardiac complications after aortic abdominal surgery
Authors
Licker, Marc
Khatchatourian, Gregory
Schweizer, Alexandre
Bednarkiewicz, Marek
Tassaux, Didier
Chevalley, Catherine
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 use — Aged — Angioplasty, Balloon, Coronary — Aorta, Abdominal/surgery — Clonidine/therapeutic use — Coronary Artery Bypass — Coronary Disease/epidemiology/prevention & control — Female — Humans — Incidence — Male — Middle Aged — Multivariate Analysis — Postoperative Complications/epidemiology/prevention & control
Identifiers
PMID: 12456411
Full text
Article (Published version) (400 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Structures
Faculté de médecine / Section de médecine clinique / Département de chirurgie
Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences
Research groups Chirurgie cardio-vasculaire (105)
Dysfonctions cardio-pulmonaires et cérébrales (278)
Citation
(ISO format) 		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. doi: 10.1097/00000539-200212000-00011 https://archive-ouverte.unige.ch/unige:46202

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Deposited on : 2015-02-02

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