Abstract 2288: Does Perioperative Diastolic Dysfunction Affect Postoperative Outcome ?
Objective: To assess the presence of perioperative diastolic dysfunction (DD) in patients undergoing vascular surgery with transesophageal echo (TEE) and its association with postoperative morbidity and mortality.
Methods: We conducted TEE examinations on 282 patients undergoing high-risk vascular surgery under general anesthesia (GA). All TEE examinations were conducted after induction of GA and endotracheal intubation. We used transmitral flow propagation velocity (Vp); a validated echocardiographic index of left ventricular filling and DD, for assessment of perioperative DD. A Vp value of < 0.45m/sec is considered diagnostic of DD. We used Fisher’s Exact Test and Pearson’s Chi-Square to compare the incidence of postoperative complications i.e. congestive heart failure (CHF), myocardial infarction (MI), arrhythmias, prolonged intubation and death in patients with and without DD. Statistical significance was set at a p-value of ≤ 0.05.
Results: There were 176 males and 102 females. The mean age in males was 68.6 and 72 years in females. We were able to assess Vp in all these patients. A total of 184 (66%) patients had Vp < 0.45 m/sec. Of these patients with DD, 60 patients (32.6%) had at least one adverse outcome. Ejection fraction (EF) was comparable between the patients with and without adverse outcomes. A Vp value of <0.45m/sec was associated with a statistically significant increase in the incidence of postoperative CHF and arrhythmias and a trend towards higher incidence of postoperative prolonged intubation but not that of MI or death (Table 1⇓).
Conclusion: Vp is an easily obtained index of left ventricular filling. Almost 2/3rd (66%) of the patients presenting for vascular surgery were diagnosed to have DD by an abnormal Vp. Presence of perioperative DD is associated with a higher incidence of postoperative complications (CHF, Arrhythmias, Prolonged Intubation).