ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2020 October;61(5):596-603

DOI: 10.23736/S0021-9509.19.11052-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Anaerobic threshold as an independent predictor of mid-term survival following elective endovascular repair of abdominal aortic aneurysm

Claire DAWKINS ¹, Andrew C. HOLLINGSWORTH ¹, Paul WALKER ², Simon MILBURN ², Gerard DANJOUX ³, Matthew CHEESMAN ³, Reza MOFIDI ¹ ✉

¹ Department of Vascular Surgery, James Cook University Hospital, Middlesbrough, UK; ² Department of Interventional Radiology, James Cook University Hospital, Middlesbrough, UK; ³ Department of Anesthesia, James Cook University Hospital, Middlesbrough, UK

BACKGROUND: The aim of this study was to examine the value preoperative AT as predictor of postoperative survival in patients who underwent elective EVAR for repair of asymptomatic AAA.
METHODS: Consecutive patients who underwent elective EVAR between 2008 and 2018 were analyzed. Cardiopulmonary exercise testing was performed. Perioperative 30-day mortality was compared between patients who had AT ≥8 mL/kg/min and those with AT<8 mL/kg/min. Risk factors for postoperative survival following EVAR were examined using Cox’s regression analysis.
RESULTS: Between 1^st January 2008 and 31^st December 2017, 430 patients underwent elective EVAR (standard device: N.=374, fenestrated/branched: N.=56); their median age was 76 years (range: 53-91 years), median AT was 9.3 (range: 5.4-16.1), and 30-day mortality was 0.9%. These patients were followed up for a median of 1630 days. There was no significant difference in perioperative 30-day mortality between patients who had AT≥8 and those who had AT<8 (χ²=1.56, P=0.22). Age (HR=1.51 [CI: 1.07-1.99], P<0.05) and AT (HR=0.59 [CI: 0.45-0.76], P=0.0003) were predictors of reduced postoperative survival following elective EVAR whereas gender (HR=0.75 [CI: 0.4-1.4], P=0.37), AAA diameter (HR=0.95 [CI: 0.77-1.16], P=0.6), and AAA morphology (HR=1.23 [CI: 0.68-1.76], P=0.95) were not.
CONCLUSIONS: Anaerobic threshold is an independent predictor of prolonged survival following elective EVAR and can be used to identify patients who receive most benefit from elective EVAR.

KEY WORDS: Abdominal aortic aneurysm; Endovascular procedures; Anaerobic threshold; Survival