Document Detail


Perioperative diastolic dysfunction during vascular surgery and its association with postoperative outcome.
MedLine Citation:
PMID:  19563954     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the association of perioperative cardiac dysfunction during elective vascular surgery with postoperative outcome.
BACKGROUND: Patients with normal systolic function can have isolated diastolic dysfunction. Routine preoperative evaluation of left ventricular (LV) function does not include an assessment of diastolic function for risk stratification. We hypothesized that perioperative assessment of both diastolic and systolic function with transesophageal echo (TEE) may improve our ability to predict postoperative outcome.
METHODS: Perioperative TEE examinations were carried out on patients undergoing elective vascular surgery under general anesthesia. Abnormal systolic function was defined as LV ejection fraction (LVEF) <40%. Left ventricular diastolic function was assessed using transmitral flow propagation velocity (Vp); Vp <45 cm/sec was considered abnormal. We determined the association between LV function and the primary outcome of postoperative adverse outcome, defined as one or more adverse events: myocardial infarction (MI), congestive heart failure (CHF), significant arrhythmia, prolonged intubation, renal failure, and death.
RESULTS: Three hundred thirteen patients undergoing vascular surgery were studied. We found that 8% (n = 24) of patients had isolated systolic dysfunction, 43% (n = 134) had isolated diastolic dysfunction, and 24% (n = 75) both systolic and diastolic dysfunction. The most common postoperative adverse outcome was CHF 20% (n = 62). By multivariate logistic regression, we found that patient age, Vp, type of surgery, female gender, and renal failure were predictive of postoperative adverse outcome.
CONCLUSION: The presence of perioperative diastolic dysfunction as assessed with Vp is an independent predictor of postoperative CHF and prolonged length of stay after major vascular surgery. Patient age, gender, type of surgery, and renal failure were also predictors of outcome. Perioperative systolic function was not a predictor of postoperative outcome in our patients.
Authors:
Robina Matyal; Philip E Hess; Balachundhar Subramaniam; John Mitchell; Peter J Panzica; Frank Pomposelli; Feroze Mahmood
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  50     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-30     Completed Date:  2009-07-09     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  70-6     Citation Subset:  IM    
Affiliation:
Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Diastole
Echocardiography, Transesophageal
Female
Humans
Male
Middle Aged
Monitoring, Physiologic
Perioperative Care
Postoperative Complications / etiology
Predictive Value of Tests
Risk Assessment
Risk Factors
Systole
Treatment Outcome
Vascular Surgical Procedures / adverse effects*
Ventricular Dysfunction, Left / complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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