Abstract 3831: Endovascular Repair of Abdominal Aortic Aneurysm is Associated with Reduced Perioperative Myocardial Ischemia During Continuous 12-Lead ECG Monitoring, Troponin T Release and All-Cause Mortality
Background: Endovascular abdominal aortic aneurysm (AAA) repair is considered to be minimally invasive and associated with reduced in-hospital complications compared to open repair. Limited information is available whether endovascular repair is associated with reduced perioperative myocardial ischemia, troponin T release and clinical outcome, corrected for preoperative dobutamine stress echocardiography results.
Methods: A total of 129 patients (mean age 69 +/-9 years, 86% male) undergoing open (n=94) or endovascular (n=35) repair of infrarenal AAA were preoperatively screened for cardiac risk factors, stress-induced myocardial ischemia during dobutamine stress echocardiography and cardioprotective medication. Myocardial ischemia was detected by continuous 12-lead electrocardiographic monitoring starting 24 hours before surgery and continued until two days after. Troponin T release was measured on day 1, 3, and 7 postoperatively and before discharge. All-cause mortality during the first 30 days after surgery was recorded.
Results: There were no significant differences in baseline characteristics between patients undergoing open or endovascular AAA repair. Myocardial ischemia, troponin T release (>0.1 ng/mL) and hospital mortality was detected in 49 (38.0%), 25 (19.4%) and 11 (8.5%) patients, respectively. The incidence of myocardial ischemia was significantly higher in the open repair group, compared to the endovascular repair group (50.0% vs 5.7%, p<0.001), also after adjustment for cardiac risk factors, dobutamine stress echocardiography results and cardioprotective medication (OR: 17.3, 95% CI: 2.8–105.4, p=0.002). Positive troponin T levels were also more frequently observed in patients undergoing open repair compared to endovascular repair (26.6% vs 0%, p=0.001). Finally, all-cause mortality occurred more frequently in patients undergoing open repair compared to endovascular repair (11.7% vs 0%, p=0.035).
Conclusion: Endovascular stent grafting for infrarenal abdominal aortic aneurysm is associated with a reduced incidence of perioperative myocardial ischemia during continuous 12-lead electrocardiographic monitoring, troponin T release and perioperative death, compared to open repair.