General anesthesia compared to regional anesthesia increased postoperative hs-cTnI by 121% at 6 h and myocardial injury occurred in 17.3% of EVAR patients.
Observational (n=104)
No
Does general anesthesia compared to regional anesthesia increase postoperative hs-cTnI levels in patients undergoing endovascular aortic repair?
General anesthesia, older age, longer surgery duration, and lower preoperative hemoglobin are associated with increased myocardial injury (elevated hs-cTnI) immediately following endovascular aortic repair.
Effect estimate: Patients under general anesthesia had 121% higher mean hs-cTnI at 6 h, 66% higher at 24 h, and 56% higher at 48 h compared to regional anesthesia (all p < 0.001)
p-value: p=<0.001
Background/Objectives: Several studies in the literature support that endovascular aortic repair (EVAR) could exert a harmful effect on heart function, causing myocardial injury. The aim of this study is to investigate the correlation of high-sensitivity cardiac troponin I (hs-cTnI) levels during the immediate postoperative period after EVAR with various factors. Methods: A total of 104 patients were enrolled from February to December 2024 prospectively and consecutively. Patient demographics, cardiovascular comorbidities, laboratory tests, including hemoglobin and hs-cTnI levels, EVAR procedure duration and type of anesthesia were recorded. A generalized linear mixed model with a Gamma distribution and log link was fitted to analyze postoperative hs-cTnI concentrations across three time points (6 h, 24 h, and 48 h). Results: The mean age of patients was 71.6 ± 7.3 years, the mean transverse AAA diameter was 5.7 ± 1.1 cm and the mean preoperative hemoglobin was 14.2 ± 1.64 g/dL. In total, 72 patients received general anesthesia and 32 patients regional anesthesia. A total of 18 patients presented myocardial injury. Patients under general anesthesia had significantly higher mean hs-cTnI than those under regional anesthesia (p < 0.01). Older age, longer operations, and higher baseline hs-cTnI all predict higher follow-up hs-cTnI. Meanwhile higher preoperative hemoglobin predicts lower hs-cTnI. Conclusions: General anesthesia compared to regional anesthesia, older age, longer surgery, and higher baseline hs-cTnI are associated with higher postoperative hs-cTnI levels, while higher preoperative hemoglobin predicts lower hs-cTnI levels. Understanding the factors that are related to myocardial injury during EVAR could contribute to the improvement in procedures in order to minimize the harmful effect of EVAR on heart function.
Abatzis-Papadopoulos et al. (Thu,) conducted a observational in Adults with infrarenal abdominal aortic aneurysm (AAA) electively managed with endovascular aortic repair (EVAR) (n=104). General anesthesia during EVAR vs. Regional (spinal) anesthesia during EVAR was evaluated on Postoperative myocardial injury defined by elevated high-sensitivity cardiac troponin I (hs-cTnI) levels above 99th percentile thresholds during immediate postoperative period after EVAR (Patients under general anesthesia had 121% higher mean hs-cTnI at 6 h, 66% higher at 24 h, and 56% higher at 48 h compared to regional anesthesia (all p < 0.001), p=<0.001). General anesthesia compared to regional anesthesia increased postoperative hs-cTnI by 121% at 6 h and myocardial injury occurred in 17.3% of EVAR patients.