Department of Cardiac Surgery, Royal Brompton and Harefield Hospital, Sydney Street, London, SW3 6NP, UK.
Department of Vascular Surgery, Triemli Hospital, Birmensdorferstrasse 496, 8063, Zürich, Switzerland.
BMC Surg. 2021 Mar 13;21(1):130. doi: 10.1186/s12893-021-01143-0.
Reliable prediction of the preoperative risk is of crucial importance for patients undergoing aortic repair. In this retrospective cohort study, we evaluated the metabolic equivalent of task (MET) in the preoperative risk assessment with clinical outcome in a cohort of consecutive patients.
Retrospective analysis of prospectively collected data in a single center unit of 296 patients undergoing open or endovascular aortic repair from 2009 to 2016. The patients were divided into four anatomic main groups (infrarenal (endo: n = 94; open: n = 88), juxta- and para-renal (open n = 84), thoraco-abdominal (open n = 13) and thoracic (endo: n = 11; open: n = 6). Out of these, 276 patients had a preoperative statement of their functional capacity in metabolic units and were evaluated concerning their postoperative outcome including survival, in-hospital mortality, postoperative complications, myocardial infarction and stroke, and the need of later cardiovascular interventions.
The median follow-up of the cohort was 10.8 months. Patients with < 4MET had a higher incidence of diabetes mellitus (p = 0.0002), peripheral arterial disease (p < 0.0001), history of smoking (p = 0.003), obesity (p = 0.03) and chronic obstructive pulmonary disease (p = 0.05). Overall in-hospital mortality was 4.4% (13 patients). There was no significant difference in the survival between patients with a functional capacity of more than 4 MET (220 patients, mean survival: 74.5 months) and patients with less than 4 MET (56 patients, mean survival: 65.4 months) (p = 0.64). The mean survival of the infrarenal cohort (n = 169) was 74.3 months with no significant differences between both MET groups (> 4 MET: 131 patients, mean survival 75.5 months; < 4 MET: 38 patients, mean survival 63.6 months. p = 0.35). The subgroup after open surgical technique with less than 4 MET had the lowest mean survival of 38.8 months. In 46 patients with > 4MET (20.9%) perioperative complications occurred compared to the group with < 4MET with 18 patients (32.1%) (p = 0.075). There were no significant differences in both groups in the late cardiovascular interventions (p = 0.91) and major events including stroke and myocardial infarction (p = 0.4) monitored during the follow up period. The risk to miss a potential need for cardiac optimization in patients > 4MET was 7%.
The functional preoperative evaluation by MET in patients undergoing aortic surgery is a useful surrogate marker of perioperative performance but cannot be seen as a substitute for preoperative cardiopulmonary testing in selected individuals. Trial registration clinicaltrials.gov, registration number NCT03617601 (retrospectively registered).
可靠的术前风险预测对接受主动脉修复的患者至关重要。在这项回顾性队列研究中，我们评估了代谢当量（MET）在连续患者队列中的临床结局的术前风险评估中的作用。
对 2009 年至 2016 年间在单一中心接受开放或血管内主动脉修复的 296 例患者的前瞻性收集数据进行回顾性分析。患者分为四个解剖主要组（肾下（腔内：n=94；开放：n=88），肾旁和肾周（开放：n=84），胸腹（开放：n=13）和胸（腔内：n=11；开放：n=6）。其中，276 例患者有术前功能能力的代谢单位陈述，并评估其术后结局，包括存活、住院死亡率、术后并发症、心肌梗死和中风以及后期心血管介入的需要。
该队列的中位随访时间为 10.8 个月。MET 值<4 的患者糖尿病（p=0.0002）、外周动脉疾病（p<0.0001）、吸烟史（p=0.003）、肥胖（p=0.03）和慢性阻塞性肺疾病（p=0.05）的发生率更高。总体住院死亡率为 4.4%（13 例）。MET 值>4 的患者（220 例，平均存活：74.5 个月）和 MET 值<4 的患者（56 例，平均存活：65.4 个月）之间的存活无显著差异（p=0.64）。肾下组（n=169）的平均存活时间为 74.3 个月，两组 MET 之间无显著差异（MET 值>4：131 例，平均存活 75.5 个月；MET 值<4：38 例，平均存活 63.6 个月。p=0.35）。接受开放手术治疗且 MET 值<4 的亚组的平均存活时间最低，为 38.8 个月。在 MET 值>4 的 46 例患者（20.9%）中发生了围手术期并发症，而 MET 值<4 的患者中则有 18 例（32.1%）（p=0.075）。在随访期间监测的晚期心血管介入（p=0.91）和主要事件（包括中风和心肌梗死）（p=0.4）在两组之间无显著差异。在 MET 值>4 的患者中，错过潜在心脏优化需求的风险为 7%。
主动脉手术患者术前通过 MET 进行的功能评估是围手术期表现的有用替代标志物，但不能替代选定个体的术前心肺测试。临床试验注册中心，注册号 NCT03617601（回顾性注册）。
