reoperative inducible ischemia and intraoperative ischemic episodes uring vascular surgery detected by transesophageal echocardiography and ECG: correlations and prognostic impact

Abstract

In high-risk vascu Iar sur)p.ca1 patt.cnts, presentm.

g wt.t,1 one or mI ore o f

....

the nsk factors for CAD and undergoing aortic reconstruction atJd / or peripheral vascular procedures, preoperative 1 sk stratification wtth JsE is a

va1uable test to 1•dent •c"y patt•cnts at orrcatcst n•s1< of

acqum• •ng peno1Ieratt•ve

myocardtal ischemtc complications. Dunng their perioperative hospital stay, those patients careful monitonng with mtraoperative TEE and pcrioJerative cTnT is warranted to idcntif\• cases of myocat-chal cellula• 111JU1\'. The incidence of subclinical myocardial ischemia \ as proved to be relativbly high (60.5'/'n). Elevation of cTnT is a specific predictive tool for perio1 erative coronary events. Due to the more virtual operative surgical and at bsthetic stresses in vascular surgery, intraoperative monitm ng of regional \JI\IlA by TEE is constdered another "m-action" predicttve test of ischemic cardiac complications.

The location of preoperative provocative ischemia is not necessarily the same as that occurnng during the perioperativc pattent stay. hn the maJorit:y of cases, the location of a N\VMA is completely different rlom the

coronary.

artery.

territory.

11resented 11reo11erativcl.y with the culrwiJI

lesion.

This phenomenon lughlightened the concept of mu ltidistrict CAD as the underlying pathology in those patients and not merely a localized lbsion to be targeted by coronary intcrventional tcchnic1ues. Systemic therapiel aiming at reducing plac1uc size, mflanunation and irregularities are expdcted to provide more promising results in such populatton.

The observation that myocardial ischemia• could be elicited at lower HR' s than attained by patiet ts who did not acc1uire this com))hcation indicated the importance of more Cat•cful pct opet-ative HR contrdl in the high-risk populations (i.e. those wtth positive DSE). We also showell that in spite of better perioperative HR levels than those measured duriAg DSE, other factors played an tmportant role 111 the release of biomalkcrs of subclinical ischemia in this surgical population.