Aortic and aneurysmal (ICVTS only)
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Preoperative hemodynamic parameters and the immediate outcome after open repair of ruptured abdominal aortic aneurysms
Salvatore Giordano 1*,
Fausto Biancari 2,
Pertti Loponen 1,
Jan-Ola Wistbacka 3,
Michael Luther 1
1 Department of Surgery, Vaasa Central Hospital, Vaasa, Finland
2 Department of Surgery, Oulu University Hospital, Oulu, Finland
3 Department of Anestesiology, Vaasa Central Hospital, Vaasa, Finland
* To whom correspondence should be addressed. E-mail: salvatoregiordano{at}yahoo.it.
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Abstract |
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Aim: The aim of this study was to evaluate the impact of preoperative cardiac function and haemodynamic parameters on the immediate outcome after repair of ruptured abdominal aortic aneurysm (RAAA). Methods: This is a retrospective review of 68 consecutive patients who underwent emergency repair of RAAA. Baseline pulmonary artery pressure, cardiac index, oxygen saturation and pulse rate were measured and recorded immediately after insertion of a pulmonary artery thermodilution catheter and before anaesthesia induction. Results: The in-hospital mortality rate was 39.7%. The area under the receiver operating characteristic (ROC) curve of cardiac index was 0.74 (95% CI 0.61-0.86), of stroke volume index was 0.78 (95% CI 0.67-0.89) and for oxygen delivery 0.72 (95% CI 0.60-0.84) for prediction of in-hospital death. The best cut-off values of cardiac index was 2.7 l/min/m2 (18.8% vs. 58.3%, OR 6.07, 95% CI 2.00-18.37), of stroke volume index was 27 ml/m2 (23.1% vs. 62.1%, OR 5.46, 95% CI 1.90-15.70) and of oxygen delivery was 370 ml/min/m2 (17.9% vs. 56.4%, OR 5.05, 95% CI 1.87-18.91). Multivariate analysis showed that patient's age (P=0.01, OR 1.23, 95% CI 1.05-1.44), stroke volume index (P=0.018, OR 0.89, 95% CI 0.81-0.98), and shock (P=0.007, OR 14.20, 95% CI 2.09-96.67) were independent predictors of in-hospital death. Conclusions: This study suggests that impaired cardiac function and suboptimal oxyhaemodynamic parameters are important determinants of death after repair of RAAA. Keywords: Abdominal aortic aneurysm; Rupture; Cardiac index; Stroke volume; Oxygen delivery; Glasgow aneurysm score
