Frontiers in Surgery (Apr 2022)

The Impact of Chronic Limb-Threatening Ischemia on Cardiac Surgery

  • Naohiro Wakabayashi,
  • Shinsuke Kikuchi,
  • Naoya Kuriyama,
  • Yuta Kikuchi,
  • Masahiro Tsutsui,
  • Hayato Ise,
  • Yuri Yoshida,
  • Daiki Uchida,
  • Atsuhiro Koya,
  • Tomonori Shirasaka,
  • Nobuyoshi Azuma,
  • Hiroyuki Kamiya

DOI
https://doi.org/10.3389/fsurg.2022.892309
Journal volume & issue
Vol. 9

Abstract

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PurposeThe effect of chronic limb threatening ischemia (CLTI) on advanced cardiac disease, which requires surgical treatment, has rarely been reported. The purpose of this study was to review the outcomes of cardiac surgery in patients with CLTI and determine the risk factors, with a particular focus on the severity of CLTI.PatientsThe baseline characteristics and outcomes of 33 patients who were treated for CLTI and underwent cardiac surgery were retrospectively analyzed. The states of CLTI were evaluated based on the Wound, Ischemia, and foot Infection (WIfI) classification system, and 33 patients were divided into the low-WIfI group (stages 1–2, n = 13) and high-WIfI group (stages 3–4, n = 20).ResultsThe in-hospital mortality rate was 0% in low-WIfI group and 35% in high-WIfI group (p = 0.027). Postoperative complications, particularly severe infections, occurred more frequently among high-WIfI group than low-WIfI group (70.0% vs. 23.1%, p < 0.01). Multivariable analysis identified foot infection grade as a WIfI classification factor and lower albumin levels as factors significantly associated with postoperative complications. The 1-year and 2-year survival rates were 84.6% and 67.7% in low-WIfI group and 45% and 28.1% in high-WIfI group, respectively (p = 0.011).ConclusionsCardiac surgery in patients with high WIfI stage was an extremely high-risk procedure. In such patients, lowering the WIfI stage by lower extremity revascularization and/or debridement of diseased parts prior to cardiac surgery can be considered.

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