Dawkins C, Hollingsworth AC, Walker P, Milburn S, Danjoux G,Cheesman M, Mofidi R

J Cardiovasc Surg (Torino). 2019 Oct 4. doi: 10.23736/S0021-9509.19.11052-X.
[Epub ahead of print]

BACKGROUND: The aim of this study was to examine the value preoperative AT as
predictor of postoperative survival in patients who underwent elective EVAR for
repair of asymptomatic AAA.
METHODS: Consecutive patients who underwent elective EVAR between 2008 and 2018
were analysed. Cardiopulmonary exercise testing was performed. Perioperative/30
day mortality was compared between patients who had AT ≥8 ml kg-1 min-1 and those
with AT<8 ml kg-1 min-1. Risk factors for postoperative survival following EVAR
were examined using Cox’s regression analysis.
RESULTS: Between 1st January 2008 and 31st December 2017, 430 patients underwent
elective EVAR (standard device: 374, fenestrated/ branched: 56), [Median age: 76
years (range: 53-91)]. Median AT was 9.3 (range: 5.4-16.1). 30-day mortality was
0.9%. These patients were followed up for a median of 1630 days. There was no
significant difference in perioperative/30 day mortality between patients who had
AT≥8 and those who had AT<8 (χ2=1.56, P=0.22). Age [HR:1.51 (CI: 1.07-1.99),
(P<0.05)] and AT [HR: 0.59 (0.45-0.76), (P=0.0003)] were predictors of reduced
postoperative survival following elective EVAR whereas gender [HR: 0.75
(0.4-0.1.4), P=0.37)], AAA diameter [HR: 0.95 (0.77-0.1.16), (P=0.6)], AAA
morphology [HR: 1.23 (0.68-1.76), (P=0.95)] were not.
CONCLUSIONS: Anaerobic threshold is an independent predictor of prolonged
survival following elective EVAR and can be used to identify patients who receive
most benefit from elective EVAR.