[Significance of hemodynamic sequelae of aortic ligation in infrarenal aneurysms of the abdominal aorta].

The operative mortality in abdominal aortic aneurysm repair is in large part attributable to a high incidence of myocardial infarction. This is a result of cardiovascular instability during aortic cross-clamping and declamping in patients with coexistent coronary artery disease. Therefore cardiodynamics (pulmonary arterial wedge pressure, PAWP; cardiac index, CJ) were studied in 31 patients during abdominal aortic aneurysm surgery. 12 patients (control) with a PAWP mean of 8 mmHg preoperatively showed impaired cardiac function after declamping and a significant fall in arterial pressure. 19 patients were volume loaded to a PAWP greater than 12 mmHg and the cyclo-oxygenase inhibitor Aspirin was given preoperatively. This resulted in improved cardiac performance with no fall in arterial pressure after declamping. Optimal volume loading and cyclo-oxygenase inhibition have the ability to prevent adverse hemodynamic responses to aortic clamping and declamping. Maintenance of optimal cardiac performance will reduce cardiovascular complications and postoperative mortality in abdominal aortic aneurysm repair.