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April 1988

The Role of Preoperative Radionuclide Left Ventricular Ejection Fraction for Risk Assessment in Carotid Surgery

Author Affiliations

From the Division of Vascular Surgery, Department of Surgery (Drs Kazmers and Zierler), and the Division of Nuclear Medicine, Department of Radiology (Dr Cerqueira), Seattle Veterans Administration Medical Center; and the University of Washington (Drs Kazmers, Cerqueira, and Zierler), Seattle.

Arch Surg. 1988;123(4):416-419. doi:10.1001/archsurg.1988.01400280022003

• Radionuclide ejection fraction (EF) and ventricular wall motion were determined in 73 patients before 82 carotid operations (79 carotid endarterectomies [CEAs] and three cervical carotid-subclavian bypasses). The EF was 55% ± 13%, ranging from 21% to 77%. Thirty-three percent (24/73) had low EF (≤50%), and 44% (28/63) had myocardial wall motion abnormalities. Perioperative cardiac complications, including myocardial infarction (Ml), new ventricular arrhythmia, or severe congestive heart failure, were present after 12.2% (10/82) of the operations. Perioperative Ml was present in 4.9% (4/82); in 50% of these it was fatal. Perioperative (30-day) stroke was present in 2.5% (2/79) of those undergoing CEA. Life table analysis revealed overall survival was lower in patients with EF of 35% or less vs those with EF over 35% during follow-up (522 ±280 days). Perioperative cardiac complications were more frequent with EF of 35% or less, occurring in 43% (3/7) vs 9% (7/75) of cases with EF over 35%. There was no statistical difference in perioperative mortality, but cumulative mortality differed, being 57% (4/7) in those with EF of 35% or less vs 11% (7/66) in patients with EF over 35%. Patients with EF of 35% or less are at increased risk for perioperative cardiac complications and reduced overall survival following carotid surgery.

(Arch Surg 1988;123:416-419)