Myocardial Injury in Treatment of AAA
Słowa kluczowe
Abstrakcyjny
Opis
Background: Traditional open surgery for abdominal aortic aneurysm (AAA) is burdened with complication risk from several organ systems, and also mortality figures of 3.5 - 5.5%. Over 50% of early mortality can be attributed to cardiovascular complications. Myocardial infarction is the dominant organ-specific cause of both early and late mortality in patients operated on for AAA. Endovascular surgery (EndoVascular Aortic Repair, EVAR) was developed during the 90's as an alternative method that is considered less invasive and more well-tolerated from a cardiovascular perspective.
Troponin T is a very sensitive and specific marker that predicts mortality in patients with acute symptoms of unstable angina and/or heart attack. Previous studies have also shown a high incidence of elevated troponin levels in patients who underwent major surgical procedures, especially vascular surgery, even in the absence of corresponding clinical or ECG-related symptoms of cardiac muscle injury. Several studies have also demonstrated that elevated troponin levels after surgery predict increased morbidity and mortality both short-term and long-term.
Objective: To prospectively compare elective open and endovascular surgery of AAA with respect to myocardial injury detectable with troponin T. Furthermore, to compare open and endovascular AAA surgery for the total number of periods of oxygen deficiency in cardiac muscle during and at early stages after surgery using a special ECG method (48-hour 3-channel Holter ECG with ST analysis).
Main aim of the study: To assess whether EVAR induce less myocardial injury compared with open repair for AAA.
Significance: Myocardial infarction is the predominant cause of mortality in open surgical procedure for AAA. In several previous studies, troponin T rise has been associated with impaired both short-term and long-term prognosis in elderly patients undergoing major elective surgery. This study may provide information on whether the endovascular technique provides a reduction in myocardial injury, measured as elevated troponin T or myocardial ischemia with 3-channel Holter ECG. In this way, our study can provide improved decision support in the choice of the most appropriate treatment method in the individual case.
Daktyle
Ostatnia weryfikacja: | 01/31/2020 |
Pierwsze przesłane: | 02/27/2020 |
Szacowana liczba przesłanych rejestracji: | 02/27/2020 |
Wysłany pierwszy: | 03/02/2020 |
Ostatnia aktualizacja przesłana: | 02/27/2020 |
Ostatnia opublikowana aktualizacja: | 03/02/2020 |
Rzeczywista data rozpoczęcia badania: | 12/31/2006 |
Szacowana data zakończenia podstawowej działalności: | 03/31/2020 |
Szacowana data zakończenia badania: | 11/30/2020 |
Stan lub choroba
Interwencja / leczenie
Procedure: AAA surgery
Faza
Grupy ramion
Ramię | Interwencja / leczenie |
---|---|
EVAR group Individuals undergoing endovascular aortic repair. n=40 | |
OR group Individuals undergoing open repair. n=40 |
Kryteria kwalifikacji
Wiek kwalifikujący się do nauki | 18 Years Do 18 Years |
Płeć kwalifikująca się do nauki | All |
Metoda próbkowania | Non-Probability Sample |
Przyjmuje zdrowych wolontariuszy | tak |
Kryteria | Inclusion Criteria: - Accepted for AAA surgery of either one of the operative techniques Exclusion Criteria: - High anesthesiological risk - Preoperative cardiac condition with EF < 25 or ischemic signs on preoperative evaluation - Severe renal insufficiency with s-creatinine >200 |
Wynik
Podstawowe miary wyników
1. Ischemic myocardial injury [Perioperative]