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

S.W. Grant, G.L. Hickey, N.A. Wisely, E.D. Carlson, R.A. Hartley, A.C. Pichel, D. Atkinson, C.N. McCollum
BJA, Volume 114, Issue 3, Pages 430–436


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.


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.


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 ( Math Eq at AT<10.2 ml kg−1 min−1, peak Math Eq<15 ml kg−1 min−1 or Math Eq 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 Math Eq<15 ml kg−1 min−1 (HR=1.63, 95% CI 1.01–2.63, P=0.046), and Math Eq at AT>42 (HR=1.68, 95% CI 1.00–2.80, P=0.049).


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.