Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair†.

Grant, SW ORCID: 0000-0003-3468-591X, Hickey, GL ORCID: 0000-0002-4989-0054, Wisely, NA, Carlson, ED, Hartley, RA, Pichel, AC, Atkinson, D and McCollum, CN (2015) Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair†. British journal of anaesthesia, 114 (3). pp. 430-436.

	Text BJA-2014-00093-JT009 R2 clean.pdf - Author Accepted Manuscript Download (194kB)
	Image (Figure 1) Figure 1.tif - Unspecified Download (477kB)
	Image (Figure 2) Figure 2.tif - Unspecified Download (501kB)
	Image (Figure 3) Figure 3.tif - Unspecified Download (833kB)

Abstract

<h4>Background</h4>Cardiopulmonary exercise testing (CPET) is increasingly used in the preoperative assessment of patients undergoing major surgery. The objective of this study was to investigate whether CPET can identify patients at risk of reduced survival after abdominal aortic aneurysm (AAA) repair.<h4>Methods</h4>Prospectively collected data from consecutive patients who underwent CPET before elective open or endovascular AAA repair  (EVAR) at two tertiary vascular centres between January 2007 and October 2012 were analysed. A symptom-limited maximal CPET was performed on each patient. Multivariable Cox proportional hazards regression modelling was used to identify risk factors associated with reduced survival.<h4>Results</h4>The study included 506 patients with a mean age of 73.4 (range 44-90). The majority (82.6%) were men and most (64.6%) underwent EVAR. The in-hospital mortality was 2.6%. The median follow-up was 26 months. The 3-year survival for patients with zero or one sub-threshold CPET value ([Formula: see text] at AT<10.2 ml kg(-1) min(-1), peak [Formula: see text]<15 ml kg(-1) min(-1) or [Formula: see text] at AT>42) was 86.4% compared with 59.9% for patients with three sub-threshold CPET values. Risk factors independently associated with survival were female sex [hazard ratio (HR)=0.44, 95% confidence interval (CI) 0.22-0.85, P=0.015], diabetes (HR=1.95, 95% CI 1.04-3.69, P=0.039), preoperative statins (HR=0.58, 95% CI 0.38-0.90, P=0.016), haemoglobin g dl(-1) (HR=0.84, 95% CI 0.74-0.95, P=0.006), peak [Formula: see text]<15 ml kg(-1) min(-1) (HR=1.63, 95% CI 1.01-2.63, P=0.046), and [Formula: see text] at AT>42 (HR=1.68, 95% CI 1.00-2.80, P=0.049).<h4>Conclusions</h4>CPET variables are independent predictors of reduced survival after elective AAA repair and can identify a cohort of patients with reduced survival at 3 years post-procedure. CPET is a potentially useful adjunct for clinical decision-making in patients with AAA.

Item Type:	Article
Uncontrolled Keywords:	Humans, Aortic Aneurysm, Abdominal, Exercise Test, Preoperative Care, Vascular Surgical Procedures, Hospital Mortality, Proportional Hazards Models, Risk Assessment, Risk Factors, Survival Analysis, Follow-Up Studies, Prospective Studies, Reproducibility of Results, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Endovascular Procedures, Elective Surgical Procedures
Depositing User:	Symplectic Admin
Date Deposited:	11 Jan 2016 10:46
Last Modified:	16 Mar 2024 16:03
DOI:	10.1093/bja/aeu383
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/2045900

Available Versions of this Item

• Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair†. (deposited 11 Jan 2016 10:46) [Currently Displayed]