PROCENA KARDIJALNOG RIZIKA U ELEKTIVNOJ HIRURGIJI ABDOMINALNE AORTE
Sažetak
Pacijenti sa aneurizmom abdominalne aorte i aortoilijačnom okluzivnom bolesti, kada je indikovano, upućuju se na elektivnu hirurgiju abdominalne aorte .Resekcija aneurizme abdominalne aorte i aortoilijačna rekonstrukcija nose visok rizik za razvoj kardiovaskularnog
morbiditeta i mortaliteta. Procena kardijalnog rizika u hirurgiji abdominalne aorte podrazumeva procenu verovatnoće nastanka neželjenih kardijalnih događaja intraoperativno ili u postoperativnom periodu. Sveukupni kardijalni rizik, procenjuje se individualno za pacijenta, uzimajući u obzir opšte stanje bolesnika, kardijalnu funkciju, funkcionalni kapacitet bolesnika, komorbitetni status i hirurški rizik vaskularne operacije. Kardijalni morbiditet i mortalitet su višestruko viši u hitnih u poređenju sa elektivnim zahvatima na abdominalnoj aorti, kod hirurškog lečenja u odnosu na endovaskularni pristup, posebno kod pacijenata sa suprarenalnim klemovanjem aorte. Pacijenti sa ishemijskom bolesti srca i srčanom insuficijencijom izloženi su visokom riziku za razvoj neželjenih kardijalnih događaja.
Patofiziološki mehanizmi koji se aktiviraju intraoperativno klemovanjem i deklemovanjem abdominalne aorte, dinamikom hemodinamskih promena, gubitkom krvi, poremećajem koagulacije i ishemijsko-reperfuzionom lezijom utiču na mogući razvoj perioperativnog infarkta, srčane insuficijencije i srčanog zastoja, u visokorizičnih pacijenta. Preoperativna procena kardijalne funkcije i kardijalnog rizika prema vodećim preporukama i skoring sistemima može promeniti pristup lečenju visokorizičnih pacijenata sa brojnim komorbiditetima i bitno uticati na smanjenje incidence perioperativnog morbiditeta i mortaliteteta.
Reference
1. Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011; 41: S1-S58.
2. Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al. European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019; 57(1): 8-93.
3. Stather PW, Sidloff DA, Rhema IA, Choke E, Bown MJ, Sayers RD. A Review of Current Reporting of Abdominal Aortic Aneurysm Mortality and Prevalence in the Literature. Eur J Vasc Endovasc Surg. 2014; 47(3): 240-242.
4. Singh K, Bønaa KH, Jacobsen BK, Bjørk L, Solberg S. Prevalence of and Risk Factors for Abdominal Aortic Aneurysms in a Population-based Study: The Tromsø Study. Am J Epidemiol. 2001; 154(3): 236-244.
5. Leriche R, Morel A. The Syndrome of Thrombotic Obliteration of the Aortic Bifurcation. Ann Surg. 1948; 127(2): 193-206.
6. Bhatt AB, Benenati JF. Aortoiliac Disease. In: Keefe NA, Haskal ZJ, Park A, Angle JF, editors. A Comprehensive Introduction to Interventional Radiology. Cham: Springer; 2018. p.331-341.
7. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007; 45:S5-S67.
8. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 64(22):e77–137.
9. Mohler ER 3rd. Peripheral arterial disease: identification and implications. Arch Intern Med. 2003; 163(19): 2306-14.
10. Hertzer NR, Beven EG, Young JR, O’Hara PJ, Ruschhaupt WF 3rd, Graor RA, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984; 199(2): 223-33.
11. Landesberg G, Beattie WS, Mosseri M, Jaffe AS, Alpert JS. Perioperative myocardial infarction. Circulation. 2009; 119(22):2936-44.
12. Landesberg G, Shatz V, Akopnik I, Wolf YG, Mayer M, Berlatzky Y, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol. 2003; 42(9): 1547-54.
13. Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022; 43(39):3826-3924.
14. Beaulieu RJ, Sutzko DC, Albright J, Jeruzal E, Osborne NH, Henke PK. Association of High Mortality With Postoperative Myocardial Infarction After Major Vascular Surgery Despite Use of Evidence-Based Therapies. JAMA Surg. 2020; 155(2):131-137.
15. Bergqvist D. Abdominal aortic aneurysms. Eur Heart J. 1997; 18(4):545-6.
16. Shteinberg D, Halak M, Shapiro S, Kinarty A, Sobol E, Lahat N, Karmeli R. Abdominal aortic aneurysm and aortic occlusive disease: a comparison of risk factors and inflammatory response. Eur J Vasc Endovasc Surg. 2000; 20(5):462-5.
17. Lindholt JS, Heickendorff L, Antonsen S, Fasting H, Henneberg EW. Natural history of abdominal aortic aneurysm with and without coexisting chronic obstructive pulmonary disease. J Vasc Surg. 1998; 28(2):226-33.
18. Bertges DJ, Goodney PP, Zhao Y, Schanzer A, Nolan BW, Likosky DS, et al. The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients. J Vasc Surg. 2010; 52:674-683, 683.e1-683.e3.
19. Bertges DJ, Neal D, Schanzer A, Scali ST, Goodney PP, Eldrup-Jorgensen J, et al. The vascular quality initiative cardiac risk index for prediction of myocardial infarction after vascular surgery. J Vasc Surg. 2016; 64(5):1411-1421.e4.
20. Chong T, Nguyen L, Owens CD, Conte MS, Belkin M. Suprarenal aortic cross-clamp position: a reappraisal of its effects on outcomes for open abdominal aortic aneurysm repair. J Vasc Surg. 2009; 49(4):873-80.
21. Landry G, Lau I, Liem T, Mitchell E, Moneta G. Open abdominal aortic aneurysm repair in the endovascular era: effect of clamp site on outcomes. Arch Surg. 2009; 144(9):811-816.
22. Diender E, Vermeulen JJM, Pisters R, van Schaik PM, Reijnen MMPJ, Holewijn S. Major adverse cardiac events after elective infrarenal endovascular aortic aneurysm repair. J Vasc Surg. 2022; 76(6):1527-1536.e3.
23. Brewster DC, Cronenwett JL, Hallett JW Jr, Johnston KW, Krupski WC, Matsumura JS, et al. Guidelines for the treatment of abdominal aortic aneurysms: report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. 2003; 37(5):1106-17.
24. Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004; 351(16):1607-18.
25. Columbo JA, Demsas F, Wanken ZJ, Suckow BD, Beach JM, Henkin S, et al. Stress testing before abdominal aortic aneurysm repair does not lead to a reduction in perioperative cardiac events. J Vasc Surg. 2021; 74(3):694-700.
26. McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004; 351(27):2795-804.
27. Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomized controlled trial. Lancet. 2008; 371(9627):1839-47.
28. West AB, Hatcher AJ, Rajani RR, Ramos CR, Benarroch-Gampel J. Impact of Preoperative Beta-blockade On Outcomes Following The Surgical Treatment of Atherosclerotic Disease. Ann Vasc Surg. 2022; 79:409.
29. Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977; 297(16):845-50.
30. Detsky AS, Abrams HB, Forbath N, Scott JG, Hilliard JR. Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med. 1986; 146(11):2131-4.
31. Samy AK, Murray G, MacBain G. Glasgow aneurysm score. Cardiovasc Surg. 1994; 2(1): 41-4.
32. Samy AK, Murray G, MacBain G. Prospective evaluation of the Glasgow Aneurysm Score. J R Coll Surg Edinb. 1996; 41(2):105-7.
33. Biancari F, Heikkinen M, Lepäntalo M, Salenius JP; Finnvasc Study Group. Glasgow Aneurysm Score in patients undergoing elective open repair of abdominal aortic aneurysm: a Finnvasc study. Eur J Vasc Endovasc Surg. 2003; 26(6):612-7.
34. Nesi F, Leo E, Biancari F, Bartolucci R, Rainio P, Satta J, et al. Preoperative risk stratification in patients undergoing elective infrarenal aortic aneurysm surgery: evaluation of five risk scoring methods. Eur J Vasc Endovasc Surg. 2004; 28(1):52-8.
35. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100(10):1043-9.
36. Ferrante AMR, Moscato U, Snider F, Tshomba Y. Controversial results of the Revised Cardiac Risk Index in elective open repair of abdominal aortic aneurysms: Retrospective analysis on a continuous series of 899 cases. Int J Cardiol. 2019; 277:224-228.