Dobutamine stress echocardiography for cardiac risk assessment before aortic surgery

Abstract

Using DSE for preoperative assessment of cardiac risk allowed us to operate on 74 of 81 patients being considered for elective aortic reconstruction, with no operative deaths and a 4.1% rate of perioperative MI. Dobutamine stress echocardiography has the ability to identify patients with asymptomatic stress-induced ischemic myocardium and its increased risk for perioperative MI (p < 0.001). Equally important, for patients with clinical indicators of CAD but without DSE-inducible ischemia, no further cardiac evaluation is necessary.

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…The use of DSE in preoperative risk assessment was evaluated in 16 studies, all published since 1991 and identified by a computerized search of the English language literature (Table 8) (146,149,160,(237)(238)(239)(240)(241)(242)(243)(244)(245)(246)(247)(248)(249). The populations predominantly but not exclusively included patients undergoing peripheral vascular surgical procedures.…”

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

“…Although supraventricular and ventricular arrhythmias were identified as independent risk factors for perioperative cardiac events in the Original Cardiac Risk Index, 48 subsequent studies indicated a lower level of risk. 37,90,91 The paucity of studies that address surgical risk conferred by arrhythmias limits the ability to provide specific recommendations. General recommendations for assessing and treating arrhythmias can be found in other CPGs.…”

“…Postoperative pain is associated with myocardial ischemia; however, the best practices for perioperative pain management have not been completely elucidated. 90,[350][351][352] Most of the literature focusing on perioperative myocardial events compares epidural analgesia with intravenous analgesia. Importantly, the potential efficacy of epidural analgesia depends on the local system of care.…”

Die Verantwortung des Anästhesisten in der präoperativen Risikoabklärung

“…Bei Unmöglichkeit eines Belastungs-EKGs mit dem Fahrrad oder der Armkurbel ist die mechanisch oder pharmakologisch (Dipyridamol, Dobutamin, Dobutamin mit Atropin) induzierte Stressechokardiografie indiziert, die bei neu erkannten oder sich verstär-kenden Wandbewegungsstörungen Hinweise auf ein schlechtes perioperatives Outcome liefert [27,41,50]. Dagegen konnte in einer Multivarianzanalyse, die klinisch-anamnestische Daten und Ergebnisse der Stressechokardiografie untersuchte, kein Faktor mit perioperativer Herzinsuffizienz oder Kammerflimmern assoziiert werden [17].…”