Locoregional anesthesia is associated with decreased cardiac complications in symptomatic heart failure patients undergoing carotid endarterectomy

Document Type

Article

Publication Date

10-1-2024

Publication Title

Journal of vascular surgery

Abstract

OBJECTIVE: Although the current literature reports no advantage for locoregional anesthesia (LRA) over general anesthesia (GA) in patients undergoing carotid endarterectomy (CEA), there remains a gap in understanding the impact of LRA on individuals with congestive heart failure (CHF). This study aims to assess whether the choice of anesthesia influences the rates of perioperative complications within this patient population.

METHODS: Using the Vascular Quality Initiative (VQI) carotid endarterectomy module, all patients undergoing CEA between 2013-2023 were identified. The subset of patients with CHF was included, and patients were divided based on the type of anesthesia received. Patient characteristics and outcomes were compared using χ(2) or Fischer's exact test as appropriate for categorical variables and the independent t-test or Mann-Whitney U test as appropriate for continuous variables. A sensitivity analysis was performed based on the symptomatic status of CHF, and the association between anesthesia modality and post-operative outcomes was studied using multivariable logistic regression analysis. The primary outcomes of this study included perioperative stroke, MI, acute heart failure (HF), and the combination of MI and acute HF defined as major cardiac complications.

RESULTS: A total of 21,292 patients (19,730 receiving GA, 1562 receiving LRA) with a diagnosis of CHF undergoing CEA were identified. On multivariable logistic regression analysis, LRA was independently associated with lower MI (odds ratio [OR]; 0.35; 95% confidence interval [CI], 0.13-0.96), acute HF (OR, 0.27; 95% CI, 0.09-0.87), major cardiac complications (OR, 0.30; 95% CI, 0.13-0.67), hemodynamic instability (OR, 0.64; 95% CI, 0.53-0.78), cranial nerve injury (OR, 0.40; 95% CI, 0.19-0.81), shunt use (OR, 0.25; 95% CI, 0.20-0.31), and neuromonitoring device use (OR, 0.20; 95% CI, 0.17-0.24) compared with GA in patients with symptomatic CHF. No difference in MI, acute HF, and major cardiac complications was seen in patients with asymptomatic CHF.

CONCLUSIONS: CEA can be performed safely in patients with CHF. Using LRA is associated with a decreased incidence of perioperative cardiac complications in patients with symptomatic HF undergoing CEA.

Medical Subject Headings

Humans; Endarterectomy, Carotid; Female; Male; Aged; Heart Failure; Risk Factors; Retrospective Studies; Treatment Outcome; Anesthesia, General; Risk Assessment; Middle Aged; Anesthesia, Conduction; Time Factors; Aged, 80 and over; Myocardial Infarction; Databases, Factual; Carotid Stenosis; Anesthesia, Local

PubMed ID

38851468

ePublication

ePub ahead of print

Volume

80

Issue

4

First Page

1131

Last Page

1138

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