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. 2024 Jun 15;13(12):3511.
doi: 10.3390/jcm13123511.

Preoperative Echocardiographic Unknown Valvopathy Evaluation in Elderly Patients Undergoing Neuraxial Anesthesia during Major Orthopedic Surgery: A Mono-Centric Retrospective Study

Antonio Coviello  1 , Dario Cirillo  1 , Maria Vargas  1 , Andrea Uriel de Siena  1 , Maria Silvia Barone  1 , Francesco Esposito  1 , Antonio Izzo  2 , Pasquale Buonanno  1 , Serena Volpe  1 , Andrea Gabriele Stingone  1 , Carmine Iacovazzo  1
Affiliations

Preoperative Echocardiographic Unknown Valvopathy Evaluation in Elderly Patients Undergoing Neuraxial Anesthesia during Major Orthopedic Surgery: A Mono-Centric Retrospective Study

Antonio Coviello et al. J Clin Med. .

Abstract

Background: The assessment of cardiac risk is challenging for elderly patients undergoing major orthopedic surgery with preoperative functional limitations. Currently, no specific cardiac risk scores are available for these critical patients. Echocardiography may be a reliable and safe instrument for assessing cardiac risks in this population. This study aims to evaluate the potential benefits of echocardiography in elderly orthopedic patients, its impact on anesthesiologic management, and postoperative Major Adverse Cardiac Events (MACEs). Methods: This is a retrospective, one-arm, monocentric study conducted at ''Federico II'' Hospital-University of Naples-from January to December 2023, where 59 patients undergoing hip or knee revision surgery under neuraxial anesthesia were selected. The demographic data, the clinical history, and the results of preoperative Echocardiography screening (pEco-s) were collected. After extensive descriptive statistics, the χ2 test was used to compare the valvopathies and impaired Left Ventricular Function (iLVEF) prevalence before and after echocardiography screening and the incidence of postoperative MACE; a p-value < 0.05 was considered statistically significant. Results: The mean age was 72.5 ± 6.9, and the prevalence of cardiac risk factors was about 90%. The cumulative prevalence of iLVEF and valvopathy was higher after the screening (p < 0.001). The pEco-s diagnosed 25 new valvopathies: three of them were moderate-severe. No patients had MACE. Conclusions: pEco-s evaluation could discover unknown heart valve pathology; more studies are needed to understand if pEco-s could affect the anesthetic management of patients with functional limitations, preventing the incidence of MACE, and assessing its cost-effectiveness.

Keywords: cardiac risk scores; orthopedic revision surgery; preoperative cardiac risk assessment; preoperative echocardiography screening; regional anesthesia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of the study.
See this image and copyright information in PMC

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