Intraoperative Hypotension and Its Impact on Cardiac Outcomes after Major Arterial Vascular Surgery: A Systematic Review

Abstract

Background: IOH has been recognized to represent one important, potentially modifiable intraoperative risk factor for patients undergoing major arterial vascular surgery with possible influences for resulting cardiac morbidity and mortality. Although there are improvements with respect to monitoring and managing hemodynamics, the scope and consequences of IOH for this at-risk surgical patient group are not well characterized. Objective: The objective of the current systematic review is regarding the formulation and discussion about the synthesized evidence regarding the relationship between intraoperative hypotension and the cardiac end points following significant arterial vascular reconstructive procedures, including aortic aneurysmal disease, carotid endarterectomies, and lower extremity revascularizations. Methods: Literature search through prominent data sources like PubMed, Embase, Cochrane Library, and Web of Science was carried out for papers from January 1, 2014, to December 2024. The studies explored and determined different cardiac conditions associated with patients who undergo arterial vascular surgery and how these conditions relate to IOH. The main outcomes identified include myocardial infarction, cardiac arrest, and mortality. The secondary outcomes include arrhythmia, cardiac failure, and increase in levels of troponin. Result: Out of the conducted research, ten studies met the inclusion criteria, constituting a total of 18,347 patients. It was clear that the used definition for IOH was quite varied. The determined numerical value for the reported hypo-tension observed in the cases of IOH varied from less than 55mmHg to less than 65mmHg. Similarly, incidence ranges varied, i.e., from 23% to 78%. The determined outcomes for those cases being affected by IOH include the following: myocardial injury after surgery (OR: 2.1-3.8), cardiac events after surgery (OR: 1.9-4.2), and risk for death within 30 days after surgery (OR: 1.6-2.9) Conclusions: Intraoperative hypotension proves to be an essential and significant independent risk factor for cardiac complications that develop with major arterial vascular surgery. Inconsistencies present with regard to definitions for Intraoperative Hypotension, which may show that threshold levels are necessary. There may be opportunities to reduce cardiac complications through improved methods of managing Intraoperative Hypotension.