Cardiac Stress in High-Risk Patients Undergoing Major Endovascular Surgery—Focus on Diastolic Function

• Published in: Journal of cardiothoracic and vascular anesthesia 2021-08, Vol.35 (8), p.2345-2354
• Main Authors: Zawadka, M., Marchel, M., Dudek, P., Andruszkiewicz, P., Jakimowicz, T., Gąsecka, A., Kutka, M., Poelaert, J.
• Format: Article
• Language: English
• Subjects: aneurysm; diastolic function; endovascular; heart failure with preserved ejection fraction; N-terminal pro-B-type natriuretic peptide; NT-proBNP; troponin
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2020.11.050

•In patients undergoing vascular procedures, the incidence of diastolic dysfunction might be as high as 50%.•Elderly patients experienced a transient deterioration in diastolic parameters after aneurysm repair.•Both NT-proBNP and troponin I increased after surgery The purpose of this study was to determine the relationship between the changes in diastolic function and their association with cardiac biomarkers in the perioperative period in patients undergoing complex endovascular aortic repair. Prospective observational study. Single-center academic hospital, central teaching hospital in Warsaw, Poland. The study comprised 27 high-risk patients scheduled for elective endovascular repair of aortic aneurysm. Complex endovascular procedure using branched endograft of the thoracoabdominal aorta. Branches of the stent grafts included renal arteries, the superior mesenteric artery, and the celiac trunk. The primary outcome was to evaluate changes in diastolic function parameters assessed with transthoracic echocardiography at two and 24 hours postoperatively. The major secondary outcomes were changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin I concentrations, systolic function parameters, hemodynamic parameters at two and 24 hours, length of hospital stay, and 30-day mortality. There was a reduction in e’ wave velocity on both the septal and lateral sides at two hours compared with the baseline (p = 0.041 and p = 0.05, respectively). There was an increase in both NT-proBNP and troponin I concentrations after surgery (p = 0.002 and p = 0.034, respectively), with troponin I peaking two hours after surgery and NT-proBNP peaking 24 hours after surgery. Patients undergoing a branched endovascular aortic repair of a thoracoabdominal aortic aneurysm experience a cardiac insult that manifests with deterioration in diastolic parameters and concomitant increases of troponin and NT-proBNP concentrations. Additional large-scale prospective studies are required to confirm this phenomenon.