Endovascular aortic repair is associated with greater hemodynamic stability compared with open aortic reconstruction

Objective: Examination of overall hemodynamic stability in patients undergoing endovascular aortic repair (EAR) compared with open aortic repair (OAR). Design: Retrospective study. Setting: University hospital setting. Participants: Seventy-two patients undergoing OAR and 17 patients undergoing EAR were studied. Interventions: None. Measurements and Main Results: Physiologic parameters were extracted every 15 seconds from computerized anesthesia records. Median values were calculated for every 2-minute epoch, and the absolute value of the fractional change in median (|FCM|) from epoch to epoch was calculated for a maximum of 5 hours during the intraoperative period. The incidence of extremes in hemodynamic parameters was compared. Data are presented as median and interquartile ranges. The frequency of |FCM| greater than 0.06 for mean arterial pressure (MAP) was significantly greater in the OAR compared with the EAR group (0.37 [0.30, 0.46] vs 0.14 [0.11, 0.21], p < 0.0001), implying greater stability in MAP during EAR. Similarly, the mean pulmonary artery pressures (MPAPs) were significantly more stable during EAR compared with OAR [frequency of |FCM| > 0.07: EAR, 0.20 [0.16, 0.27] vs OAR, 0.32 [0.26, 0.39]; p < 0.01). No intergroup differences were detected in heart rate (HR), systolic (SPAP) or diastolic pulmonary artery pressures (DPAP), or central venous pressures (CVPs). With the exception of a greater incidence of low CVP during EAR, there were no significant differences in the frequency of extremes of hemodynamic values between groups. Conclusion: These results show improved hemodynamic stability during EAR compared with OAR.