Endovascular aortic aneurysm repair may be easier on heart than open repair

המידע מתוך medicontext.co.il

LONDON (Reuters Health) – Endovascular abdominal aortic aneurysm (AAA) repair is associated with less severe haemodynamic changes and a lower incidence of myocardial ischaemia than open aneurysm repair, according to a report published in the August issue of the British Journal of Surgery.

Dr. P. W. M. Cuypers, from Catharina Hospital in Eindhoven, the Netherlands, and colleagues assessed intra- and postoperative cardiac-related outcomes of 76 patients with an abdominal aortic aneurysm who were randomized to undergo endovascular or open repair.

After aortic occlusion, endovascular repair was associated with a significantly smaller decrease in systemic vascular resistance than open repair, the authors note (p = 0.03). In addition, during and after aortic occlusion, the stroke work index decreased during open repair, while it increased during endovascular repair.

The frequency of postoperative cardiac complications was similar in each group. However, myocardial ischaemia was more common among open repair patients than among endovascular repair patients.

"One of the potential advantages of endovascular AAA repair is that the severity of cardiac stress may be reduced, which could eventually reduce the operative mortality rate," the researchers state. However, "to date, several comparative studies have failed to demonstrate any reduction in cardiac morbidity and mortality rates with endovascular AAA repair," they add.

"A randomized trial is the most effective study design to ascertain comparability of treatment groups," the investigators emphasize. The previous studies investigating the cardiac effects of endovascular AAA repair "were not randomized, but contained historical controls with contemporary patients, features that preclude a proper comparison," they add.

Dr. Cuypers' team believes that "clinical studies with longer followup are needed to demonstrate any potential extended beneficial effect of endovascular AAA repair on clinical events and mortality rate."

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