Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair

Grant, S. W.; Hickey, G. L.;
Wisely, N. A.; Carlson, E. D.; Hartley, R. A.; Pichel, A. C.; Atkinson,
D.; McCollum, C. N..

British Journal of Anaesthesia, March 2015,
Vol. 114 Issue: Number 3 p430-430, 1p;

Background 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.
Results. 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   AT<10.2 ml kg−1 min−1, peak VO2<15 ml
kg−1 min−1 or Ve/VO2 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 VO2<15 ml kg−1 min−1 (HR=1.63, 95% CI 1.01–2.63, P=0.046), and
Ve/VCO2 at AT>42.(HR=1.68, 95% CI 1.00–2.80, P=0.049).
Conclusions</st> 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.