Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan.
Spine and Spinal cord Surgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi Prefecture, Japan.
Spine (Phila Pa 1976). 2023 Jun 15;48(12):832-842. doi: 10.1097/BRS.0000000000004622. Epub 2023 Mar 13.
Prospective comparative study.
The objective of this study was to investigate perioperative cardiac function using echocardiography in patients undergoing surgery for the adult spinal deformity (ASD).
Corrective surgery for ASD has increased, especially in older persons. However, perioperative complication rates remain high in ASD surgery, including cardiopulmonary complications.
This study included patients with ASD who underwent surgery between May 2016 and April 2018. A cardiologist performed all echocardiography imaging preoperatively and 2 weeks postoperatively. Left ventricular contractility was measured using left ventricular ejection fraction (LVEF), and right ventricular contractility was measured using tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (S'). Spinopelvic radiographic parameters, the apices of thoracic kyphosis and lumbar lordosis, and the inflection point where the vertebral curvature changes from kyphosis to lordosis were also measured. Differences between preoperative and postoperative measurements for continuous variables were analyzed using a paired Student t test. Differences in continuous and categorical variables between two independent groups were analyzed using an unpaired Student t test and Fisher exact test, respectively. Multivariate logistic regression analyses were performed to detect influential factors.
Sixty-one patients were included [12 males and 49 females; average age, 64.0 (22-84) yr]. LVEF, TAPSE, and S', respectively changed from 64.4%, 24.9 mm, and 14.3 cm/s to 65.4%, 25 mm, and 15 cm/s postoperatively with no significance. However, in LVEF<59.3% (average-1 SD), TAPSE<17 mm, and S'<11.8 cm/s cases, respectively, these increased significantly from 55.7%, 17.9 mm, and 10.5 cm/s to 60.9%, 21.4 mm, and 14.2 cm/s postoperatively ( P =0.036, 0.029, and 0.022, respectively). The LVEF<59.3% group showed a significantly lower inflection point level (1.5 vs. 2.9) preoperatively ( P =0.007). The S'<11.8 cm/s group showed significantly larger thoracic kyphosis (28.3° vs. 19.4°) preoperatively ( P =0.013).
Perioperative cardiac function did not deteriorate after surgery in patients with ASD. In those with lower cardiac function preoperatively, there were significant improvements noted postoperatively. The preoperative inflection point level was significantly lower in the lower LVEF group. Preoperative thoracic kyphosis was significantly larger in the lower tricuspid annular peak systolic velocity group.
前瞻性对比研究。
本研究旨在通过超声心动图评估接受成人脊柱畸形（ASD）手术患者的围手术期心功能。
ASD 的矫形手术有所增加，尤其是在老年人中。然而，ASD 手术的围手术期并发症发生率仍然很高，包括心肺并发症。
本研究纳入了 2016 年 5 月至 2018 年 4 月间接受手术治疗的 ASD 患者。一名心脏病专家在术前和术后 2 周进行所有超声心动图检查。左心室收缩功能采用左心室射血分数（LVEF）进行测量，右心室收缩功能采用三尖瓣环平面收缩位移（TAPSE）和三尖瓣环收缩期峰值速度（S'）进行测量。脊柱骨盆影像学参数，包括胸椎后凸和腰椎前凸的顶点，以及脊柱弯曲从后凸向前凸变化的拐点也进行了测量。采用配对学生 t 检验分析连续变量术前与术后测量值的差异。采用独立样本学生 t 检验和 Fisher 确切概率法分别分析连续变量和分类变量在两组间的差异。采用多因素逻辑回归分析检测影响因素。
共纳入 61 例患者[12 例男性，49 例女性；平均年龄 64.0（22-84）岁]。LVEF、TAPSE 和 S'分别从术前的 64.4%、24.9mm 和 14.3cm/s 变化至术后的 65.4%、25mm 和 15cm/s，无显著差异。然而，在 LVEF<59.3%（平均-1SD）、TAPSE<17mm 和 S'<11.8cm/s 的患者中，这些参数分别从术前的 55.7%、17.9mm 和 10.5cm/s 显著增加至术后的 60.9%、21.4mm 和 14.2cm/s（P=0.036、0.029 和 0.022）。LVEF<59.3%组术前拐点水平明显较低（1.5 比 2.9）（P=0.007）。S'<11.8cm/s 组术前胸腰椎后凸角明显较大（28.3°比 19.4°）（P=0.013）。
ASD 患者术后心功能无恶化。术前心功能较低的患者，术后有明显改善。LVEF 较低组的术前拐点水平明显较低。S'较低组的术前胸腰椎后凸角明显较大。
