Ccirzli<,~<l,st((/tdr ,’iur,yvm,Vol. 4, No. 6, Pp. 724–726, 1996 Cupyn.ght Q (996 The Iutem:itional Society l“orCdiovaxular Surgery PublMcd by Ekvim Science Ltd. Printed in (hut Rritnin 0967-21UW6 $’15,U()+ U,(lo PII: SO967-21O9(96)OOO31-2 R e s o1 0 c o n s e l a b a o r a n e r e p W. E. Lloyd, 1?S. K. Paty,R, C, Darling Ill, B. B. Chang,K. M. Fitzgerald, R. P.Leatherand D. M.Shah Vascu/arSurgerySection,AlbanyMedica/College,AlbanyNew York,USA Inorderto identifimajorrisksfordeathandcomplications fromelectiverepairofabdominal aortic aneurysm,theauthorsanalyzedtheirexperiencewiththelast1000 suchrepairsovera 15-year period.Ofthepatients,772 weremenand228 werewomen;averageagewas70 (range37-92) years.Some20?J0ofthepatientshadseverechronicobstructivepulmonarydiseaseand33?40had baselinecreatinine level > 115pmol/1. Fifteen patients were dialysis-dependent and 24% (242/1000) hadsignificantcardiacdisease.Operationuseda retroperitoneal approachin 834 patientsanda transperitoneal approachin 166.Theperioperativemortalityratewas2.4?40, but thisdidnotchangeeitherchronologically orwithtechnique:some50?40 ofthedeathsweredueto cardiaccauses.Renalandpulmonary impairmentdidnotaffectmortalityorcomplication; 64°Aof non-fatalcomplicationswere distributedin the renal (17~0), pulmonary(19Yo)and cardiac groups(28Yo).The authors’experienceshowedthat patientswith cardiacdiseaseremainat significantrisk for post-abdominal aortic aneurysmrepair complications in spite of selective preoperativecardiacevaluation.Renaland pulmonaryrisk factors did not causeadditional mortalityor morbidity.They suggestthat electiveabdominalaortic aneurysmrepair can be performedwith lowmortalityandmorbidity,evenin increasingnumbersof high-riskpatients. Copyright@ 1996 TheInternational Society for Cardiovascular Surgery. Keywords: risk factors, aneurysms Over the past40 years since the first successful aortic replacement, mortality rates of elective repair of infra- renal abdominal aortic aneurysm have declined sig- nificantly, with current mortaIity rates averaging less than 5~0 in major centers1. These improvements are largely the result of refinements in operative technique and perioperative management. These advances have also translated to improved perioperative morbidity rates. Despite these improvements,some groups of patients with impairedcardiac, pulmonaryor renal function have beendeemedat increasedrisk for perioperativemortality I 7 In this study the authors’ elective and morbidity – . aneurysmexperiencewasretrospectivelyreviewedwitha view to identify such risk factors and their contribution to postoperativemorbidity and mortality. Presented at the International Society for Cardiovascular Surgery Congress, Kyrrto, Japan, Septembm- 1995 Correspondence to: Dr D. M. Shah, Vascular Surgery, A-61, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA 724 Patients and methods The records of all patients undergoing elective aortic replacement for infrarenal abdominal aortic aneurysm in the Albany Medical Center between 1979 and 1994 were retrospectively reviewed. The presence of pre- operative risk factors related to cardiac, pulmonary or renal organ systems was noted. Cardiac dysfunction was identified through pre- operative history of angina, congestive heart failure, cardiac arrhythmia, valvular dysfunction, physical examination, electrocardiographiccriteria, or the results of prior non-invasive or invasive testing. Preoperative persantine thallium studies were performed on 155 patients. Of these, only 35 underwent preoperative cardiac catheterization and 11 had coronary bypass surgery before abdominal aortic aneurysm, with no mortality. Significant pulmonary disease was identified where there was a preoperative history of chronic obstructive pulmonary disease or arterial oxygen level on room air arterial blood gas of <50 mmHg. In addition, if pulmonary function testing was performed, CARD1OVASCULARSURGERY DECEMBER 1996 VOL 4 NO 6