Anaerobic Threshold (AT) is an independent predictor of medium term survival following elective endovascular repair of abdominal aortic aneurysm (EVAR)

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.