Does Adult Spinal Deformity Affect Cardiac Function? -A Prospective Perioperative Study.

STUDY DESIGN: Prospective comparative study.

OBJECTIVE: To investigate perioperative cardiac function using echocardiography in patients undergoing surgery for adult spinal deformity (ASD).

SUMMARY OF BACKGROUND DATA: Corrective surgery for ASD has increased, especially in older persons. However, perioperative complication rates remain high in ASD surgery, including cardiopulmonary complications.

METHODS: This study included patients with ASD who underwent surgery between May 2016 and April 2018. A cardiologist performed all echocardiography imaging preoperatively and 2 weeks postoperatively. Left ventricular contractility was measured using left ventricular ejection fraction (LVEF), and right ventricular contractility was measured using tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (S'). Spino-pelvic radiographic parameters, the apices of thoracic kyphosis and lumbar lordosis, and the inflection point where the vertebral curvature changes from kyphosis to lordosis were also measured. Differences between pre- and postoperative measurements for continuous variables were analyzed using a paired Student t test. Differences in continuous and categorical variables between two independent groups were analyzed using an unpaired Student t test and Fisher's exact test, respectively. Multivariate logistic regression analyses were performed to detect influential factors.

RESULTS: Sixty-one patients were included (12 males and 49 females; average age, 64.0 [22-84] years). LVEF, TAPSE, and S' respectively changed from 64.4%, 24.9 mm, and 14.3 cm/s to 65.4%, 25 mm, and 15 cm/s postoperatively with no significance. However, in LVEF<59.3% (average-1 standard deviation), TAPSE<17 mm, and S'<11.8 cm/s cases respectively, these increased significantly from 55.7%, 17.9 mm, and 10.5 cm/s to 60.9%, 21.4 mm, and 14.2 cm/s postoperatively (P=0.036, P=0.029, and P=0.022, respectively). The LVEF<59.3% group showed a significantly lower inflection point level (1.5 vs. 2.9) preoperatively (P=0.007). The S'<11.8 cm/s group showed significantly larger thoracic kyphosis (TK) (28.3° vs. 19.4°) preoperatively (P=0.013).

CONCLUSION: Perioperative cardiac function did not deteriorate after surgery in patients with ASD. In those with lower cardiac function pre-operatively, there were significant improvements noted postoperatively. The preoperative inflection point level was significantly lower in the lower left ventricular ejection fraction group. Preoperative TK was significantly larger in the lower tricuspid annular peak systolic velocity group.