Abraham Ned, Lemech Lubomyr, Sandroussi Charbel, Sullivan David, May James
Department of Vascular Surgery, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
J Vasc Surg. 2005 Mar;41(3):377-80; discussion 380-1. doi: 10.1016/j.jvs.2004.11.038.
Endovascular repair of abdominal aortic aneurysms (AAAs) is considered to be less invasive and better tolerated by the cardiovascular system than open repair. Our aim was to assess the true incidence of perioperative myocardial damage associated with endovascular vs open infrarenal AAA repair.
Between July 1999 and June 2001, preoperative and postoperative serum troponin T (TnT) levels were measured in all patients presenting for elective AAA repair at Royal Prince Alfred Hospital. The incidence of myocardial damage was recorded on the basis of standard clinical, biochemical, and electrocardiographic changes or a subclinical increase of 50% or more in serum TnT. Patients were excluded if the TnT increase was associated with a significant increase of serum creatinine (> or =50%) with no other evidence of myocardial ischemia. The differences between the two groups were analyzed with the chi 2 test and odds ratios.
A total of 35 open and 112 endovascular AAA repairs were included in the study. There was no significant difference in age, sex, preoperative serum creatinine, or preoperative serum TnT between the two treatment groups. Seventeen patients had biochemical evidence of myocardial damage, which was clinically obvious in only one patient. Even though the incidence of previous myocardial infarction was significantly higher in patients undergoing endovascular repair (41%) than open repair (22%; P < .05), the overall incidence of myocardial damage (clinical or subclinical) was significantly higher in the open group compared with the endovascular group (8 [25%] of 32 vs 9 [8%] of 109, respectively; odds ratio, 3.7; 95% confidence interval, 1.28-10.49; P < .02).
There is a previously underestimated incidence of subclinical myocardial damage associated with surgery for infrarenal AAA which is lower after endovascular than open repair.
与开放性修复相比，腹主动脉瘤（AAA）的血管内修复被认为具有微创性且心血管系统耐受性更好。我们的目的是评估血管内修复与开放性肾下AAA修复相关的围手术期心肌损伤的真实发生率。
在1999年7月至2001年6月期间，对在皇家阿尔弗雷德王子医院接受择期AAA修复的所有患者进行术前和术后血清肌钙蛋白T（TnT）水平测量。根据标准的临床、生化和心电图变化或血清TnT亚临床升高50%或更多来记录心肌损伤的发生率。如果TnT升高与血清肌酐显著升高（≥50%）相关且无其他心肌缺血证据，则将患者排除。两组之间的差异采用卡方检验和比值比进行分析。
该研究共纳入35例开放性和112例血管内AAA修复病例。两个治疗组在年龄、性别、术前血清肌酐或术前血清TnT方面无显著差异。17例患者有心肌损伤的生化证据，其中仅有1例临床上明显。尽管接受血管内修复的患者既往心肌梗死发生率（41%）显著高于开放性修复患者（22%；P<.05），但开放性组心肌损伤（临床或亚临床）的总体发生率显著高于血管内组（分别为32例中的8例[25%]和109例中的9例[8%]；比值比为3.7；95%置信区间为1.28 - 10.49；P<.02）。
肾下AAA手术相关的亚临床心肌损伤发生率此前被低估，血管内修复后的发生率低于开放性修复。
