Cardiac Complication After Vascular Surgery

Study Overview
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Brief Summary
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The vascular surgery is a highest risk procedure when considering postoperative complications associated with the cardiovascular system. The leading clinical presentation is acute hemodynamic decompensation. However, one of the possible pathomechanisms might be repolarization disturbances. Many of perioperative risk factors of cardiac complications are modifiable. The identification may help in the global perioperative risk reduction. Aim: The aim of the study was an identification of the factors which may release clinically overt repolarization disturbances. Methods: The study group consisted of 100 patients, diagnosed with abdominal subrenal aortic aneurysms or peripheral arterial disease scheduled for an elective open vascular surgery procedure. The authors investigated whether age, gender, comorbidities or some perioperative factors (including hemodynamic, metabolic or genetic) were related to the occurrence of clinically concealed repolarization disturbances or clinically disclosed cardiac complications in postoperative time up to 30 day and one year after vascular surgery procedure.

Detailed Description
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Vascular surgery is thought as the highest risk procedure in the context of cardiac complications. The range may include acute coronary syndrome, acute circulatory failure, severe arrhythmias, syncope and sudden cardiac death. The patient population is considered as a high risk, too. Popular calculators used for risk stratifications are based on preoperative patient's history and some general laboratory results. However, general status of the patient changes dynamically during vascular procedures leading to acquired increased risk. For this reason, sole preoperative risk prediction based on standard calculators is unsuitable and suboptimal. Advanced monitoring systems may record some temporary disturbances (e.g. ventricular repolarization disturbances), which may be asymptomatic. The clinical significance in postoperative risk prediction of such observations remains undefined. On the other hand, many of perioperative cardiac complications are caused by modifiable factors. The identification may help in the global perioperative risk reduction.

Official Title
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The Reasons of Repolarization Disturbances Disclosure in Vascular Surgery

Conditions
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Aortic Aneurysm, Abdominal, Ventricular Arrythmia, Peripheral Arterial Disease, Cardiac Complication

Intervention / Treatment
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* Other: vascular surgery procedure


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adult patients diagnosed with abdominal subrenal aortic aneurysms or peripheral arterial disease scheduled for an elective open vascular surgery procedure Exclusion Criteria: heart stimulation, atrioventricular and intraventricular conduction defects, atrial fibrillation recorded before of the study, antiarrhythmic drug treatment (except beta-blockers), unoptimal patient general status (uncontrolled diabetes, active infection) reoperation emergency operations

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| vascular surgery patients<br>clinically concealed repolarization disturbances during vascular surgery procedure clinically disclosed cardiac complications during and after vascular surgery procedure | Other: vascular surgery procedure<br>* an elective open vascular surgery procedure ECG Holter recording during the procedure and 24 hours after operation (continuous electrocardiographic tracing (digital Holter ECG monitor)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| cardiac complications | cardiac complications according to European Society of Cardiology | up to 30 days after vascular procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| cardiac complications | cardiac complications according to European Society of Cardiology | during surgical procedure | 
| cardiac complications | cardiac complications according to European Society of Cardiology | one year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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vascular surgery, repolarization disturbances, cardiac complications, high risk patient, high risk procedure