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The Journal of Cardiovascular Surgery 2019 Oct 04

DOI: 10.23736/S0021-9509.19.11052-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Anaerobic Threshold (AT) is an independent predictor of medium term survival following elective endovascular repair of abdominal aortic aneurysm (EVAR)

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 Radiology, James Cook University Hospital, Middlesbrough, UK; 3 Anaesthesia, James Cook University Hospital, Middlesbrough, UK


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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 analysed. Cardiopulmonary exercise testing was performed. Perioperative/30 day mortality was compared between patients who had AT ≥8 ml kg−1 min−1 and those with AT<8 ml kg−1 min−1. Risk factors for postoperative survival following EVAR were examined using Cox’s regression analysis.
RESULTS: Between 1st January 2008 and 31st December 2017, 430 patients underwent elective EVAR (standard device: 374, fenestrated/ branched: 56), [Median age: 76 years (range: 53-91)]. Median AT was 9.3 (range: 5.4-16.1). 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 (0.45-0.76), (P=0.0003)] were predictors of reduced postoperative survival following elective EVAR whereas gender [HR: 0.75 (0.4-0.1.4), P=0.37)], AAA diameter [HR: 0.95 (0.77-0.1.16), (P=0.6)], AAA morphology [HR: 1.23 (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: Anaerobic Threshold; EVAR; Abdominal aortic aneurysm; Survival

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