Journal of Vascular Surgery
Volume 50, Issue 1 , Pages 70-76, July 2009

Perioperative diastolic dysfunction during vascular surgery and its association with postoperative outcome

  • Robina Matyal, MD

      Affiliations

    • Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
    • ,
  • Philip E. Hess, MD

      Affiliations

    • Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
    • ,
  • Balachundhar Subramaniam, MD

      Affiliations

    • Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
    • ,
  • John Mitchell, MD

      Affiliations

    • Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
    • ,
  • Peter J. Panzica, MD

      Affiliations

    • Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
    • ,
  • Frank Pomposelli, MD

      Affiliations

    • Department of Vascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
    • ,
  • Feroze Mahmood, MD

      Affiliations

    • Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
    • Corresponding Author InformationReprint requests: Feroze Mahmood, MD, Director of Vascular Anesthesia, Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Received 3 October 2008; accepted 18 December 2008.

Objective

To assess the association of perioperative cardiac dysfunction during elective vascular surgery with postoperative outcome.

Background

Patients with normal systolic function can have isolated diastolic dysfunction. Routine preoperative evaluation of left ventricular (LV) function does not include an assessment of diastolic function for risk stratification. We hypothesized that perioperative assessment of both diastolic and systolic function with transesophageal echo (TEE) may improve our ability to predict postoperative outcome.

Methods

Perioperative TEE examinations were carried out on patients undergoing elective vascular surgery under general anesthesia. Abnormal systolic function was defined as LV ejection fraction (LVEF) <40%. Left ventricular diastolic function was assessed using transmitral flow propagation velocity (Vp); Vp <45 cm/sec was considered abnormal. We determined the association between LV function and the primary outcome of postoperative adverse outcome, defined as one or more adverse events: myocardial infarction (MI), congestive heart failure (CHF), significant arrhythmia, prolonged intubation, renal failure, and death.

Results

Three hundred thirteen patients undergoing vascular surgery were studied. We found that 8% (n = 24) of patients had isolated systolic dysfunction, 43% (n = 134) had isolated diastolic dysfunction, and 24% (n = 75) both systolic and diastolic dysfunction. The most common postoperative adverse outcome was CHF 20% (n = 62). By multivariate logistic regression, we found that patient age, Vp, type of surgery, female gender, and renal failure were predictive of postoperative adverse outcome.

Conclusion

The presence of perioperative diastolic dysfunction as assessed with Vp is an independent predictor of postoperative CHF and prolonged length of stay after major vascular surgery. Patient age, gender, type of surgery, and renal failure were also predictors of outcome. Perioperative systolic function was not a predictor of postoperative outcome in our patients.

 

 Competition of interest: none.

PII: S0741-5214(08)02271-4

doi:10.1016/j.jvs.2008.12.032

Journal of Vascular Surgery
Volume 50, Issue 1 , Pages 70-76, July 2009

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