Wakabayashi Naohiro, Kikuchi Shinsuke, Kuriyama Naoya, Kikuchi Yuta, Tsutsui Masahiro, Ise Hayato, Yoshida Yuri, Uchida Daiki, Koya Atsuhiro, Shirasaka Tomonori, Azuma Nobuyoshi, Kamiya Hiroyuki
Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan.
Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan.
Front Surg. 2022 Apr 28;9:892309. doi: 10.3389/fsurg.2022.892309. eCollection 2022.
The effect of chronic limb threatening ischemia (CLTI) on advanced cardiac disease, which requires surgical treatment, has rarely been reported. The purpose of this study was to review the outcomes of cardiac surgery in patients with CLTI and determine the risk factors, with a particular focus on the severity of CLTI.
The baseline characteristics and outcomes of 33 patients who were treated for CLTI and underwent cardiac surgery were retrospectively analyzed. The states of CLTI were evaluated based on the Wound, Ischemia, and foot Infection (WIfI) classification system, and 33 patients were divided into the low-WIfI group (stages 1-2, = 13) and high-WIfI group (stages 3-4, = 20).
The in-hospital mortality rate was 0% in low-WIfI group and 35% in high-WIfI group (= 0.027). Postoperative complications, particularly severe infections, occurred more frequently among high-WIfI group than low-WIfI group (70.0% vs. 23.1%, < 0.01). Multivariable analysis identified foot infection grade as a WIfI classification factor and lower albumin levels as factors significantly associated with postoperative complications. The 1-year and 2-year survival rates were 84.6% and 67.7% in low-WIfI group and 45% and 28.1% in high-WIfI group, respectively (= 0.011).
Cardiac surgery in patients with high WIfI stage was an extremely high-risk procedure. In such patients, lowering the WIfI stage by lower extremity revascularization and/or debridement of diseased parts prior to cardiac surgery can be considered.
慢性肢体威胁性缺血（CLTI）对需要手术治疗的晚期心脏病的影响鲜有报道。本研究的目的是回顾CLTI患者心脏手术的结果并确定危险因素，特别关注CLTI的严重程度。
回顾性分析33例接受CLTI治疗并接受心脏手术患者的基线特征和结果。根据伤口、缺血和足部感染（WIfI）分类系统评估CLTI状态，33例患者分为低WIfI组（1-2期，n = 13）和高WIfI组（3-4期，n = 20）。
低WIfI组的住院死亡率为0%，高WIfI组为35%（P = 0.027）。高WIfI组术后并发症，尤其是严重感染，比低WIfI组更频繁发生（70.0%对23.1%，P < 0.01）。多变量分析确定足部感染等级为WIfI分类因素，较低的白蛋白水平为与术后并发症显著相关的因素。低WIfI组的1年和2年生存率分别为84.6%和67.7%，高WIfI组分别为45%和28.1%（P = 0.011）。
高WIfI分期患者的心脏手术是极高风险的手术。对于此类患者，可考虑在心脏手术前通过下肢血运重建和/或清创病变部位来降低WIfI分期。
