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CARDIOVASCULAR ANESTHESIA

The Impact of a Cardioprotective Protocol on the Incidence of Cardiac Complications After Aortic Abdominal Surgery

Marc Licker, MD^*, Gregory Khatchatourian, MD, Alexandre Schweizer, MD^*, Marek Bednarkiewicz, MD, Didier Tassaux, MD^*, and Catherine Chevalley, MD^*

*Division of Anesthesiology and Clinic of Cardiovascular Surgery, University Hospital, Geneva, Switzerland

Address correspondence and reprint requests to Marc Licker, MD, Département d’Anesthésiologie, Pharmacologie et Soins Intensifs Chirurgicaux, Hopital Universitaire, rue Micheli-Ducrest, CH-1211 Genève 14, Switzerland. Address e-mail to licker-marc- joseph{at}hcuge.ch

We analyzed a local database including 468 consecutive patients who underwent elective aortic abdominal surgery over an 8-yr period in a single institution. A new cardioprotective perioperative protocol was introduced in January 1997, and we questioned whether perioperative cardiac outcome could be favorably influenced by the application of a stepwise cardiovascular evaluation based on the American College of Cardiology/American Heart Association guidelines and by the use of antiadrenergic drugs. Clonidine was administered during surgery, and ß-blockers were titrated after surgery to achieve heart rates less than 80 bpm. We compared data of two consecutive 4-yr periods (1993–1996 [control period] versus 1997–2000 [intervention period]). Implementation of American College of Cardiology/American Heart Association guidelines was associated with increased preoperative myocardial scanning (44.3% vs 20.6%; P < 0.05) and coronary revascularization (7.7% vs 0.8%; P < 0.05). During the intervention period, there was a significant decrease in the incidence of cardiac complications (from 11.3% to 4.5%) and an increase in event-free survival at 1 yr after surgery (from 91.3% to 98.2%). Multivariate regression analysis showed that the combined administration of clonidine and ß-blockers was associated with a decreased risk of cardiovascular events (odds ratio, 0.3; 95% confidence interval, 0.1–0.8), whereas major bleeding, renal insufficiency, and chronic obstructive pulmonary disease were predictive of cardiac complications. In conclusion, cardiac testing was helpful to identify a small subset of high-risk patients who might benefit from coronary revascularization. Sequential and selective antiadrenergic treatments were associated with improved postoperative cardiac outcome.

IMPLICATIONS: Implementation of American College of Cardiology/American Heart Association guidelines and use of antiadrenergic drugs were associated with better cardiac outcomes after major vascular surgery.

This article has been cited by other articles:

				A. Auerbach and L. Goldman Assessing and Reducing the Cardiac Risk of Noncardiac Surgery Circulation, March 14, 2006; 113(10): 1361 - 1376. [Full Text] [PDF]

				G. Godet, I. Arhanghelschi, C. Chevalley, and M. Licker The Impact of a Cardioprotective Protocol on the Incidence of Cardiac Complications After Aortic Abdominal Surgery * Response Anesth. Analg., June 1, 2003; 96(6): 1846 - 1846. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999