scholarly journals Anaesthesia and ICU sedation with sevoflurane do not reduce myocardial injury in patients undergoing cardiac surgery

Medicine ◽  
2020 ◽  
Vol 99 (50) ◽  
pp. e23253
Author(s):  
Pierre-Grégoire Guinot ◽  
Omar Ellouze ◽  
Sandrine Grosjean ◽  
Vivien Berthoud ◽  
Tiberiu Constandache ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Myocardial Injury ◽  
Icu Sedation

Correspondence on “Association between cardiologist evaluation and mortality in myocardial injury after non-cardiac surgery” by Park et al

Heart ◽  
2021 ◽  
pp. heartjnl-2021-320436 ◽  
Author(s):  
Daria Müller ◽  
Noemi Glarner ◽  
Pedro Lopez-Ayala ◽  
Christian Puelacher ◽  
Christian Müller
Keyword(s):  
Cardiac Surgery ◽  
Myocardial Injury

Ischemic Cardiac Event

2019 ◽  
Author(s):  
Megan Lanigan ◽  
Matthew Culling ◽  
Robert Gould ◽  
Michael Wall ◽  
Joss Thomas
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Disease ◽  
Cardiac Event ◽  
Myocardial Injury ◽  
High Cholesterol ◽  
Cardiac Events ◽  
Troponin Elevation ◽  
Adverse Cardiac Events ◽  
Common Causes ◽  
Artery Disease

An estimated 92.1 million Americans have at least one type of cardiovascular disease (CAD).1  Even though death rates due to CAD have declined, at least 2200 Americans die each day of CAD. 2 In the U.S. at least 50 million operations occur every year and up to 4% are associated with adverse cardiac events. 3There are many identifiable risk factors for cardiac disease such as diabetes, hypertension, obesity, smoking, and high cholesterol. 1In addition, there are non-modifiable risks for cardiac disease; these include age, gender, family history, and homocysteine levels. 4 Hypotension and tachycardia are the most common causes of ischemic cardiac events in the intra-operative phase. The failure to detect myocardial injury early on may contribute to complications as long as 30 days post-operatively. Typically, ischemic findings on electrocardiography and elevated troponin measurements have been used as potential indicators of ischemia or myocardial injury after non-cardiac surgery in the peri-operative setting. In the treatment of ischemic cardiac events, intensified medical therapy (antiplatelet, beta-blocker, ACE inhibitor, or a statin) in patients who suffered from a troponin elevation in the postoperative period reduces the risk of having a major cardiac event within a year.  This review contains 1 figure, 2 tables, and 74 references.  Keywords: Myocardial Injury after Non Cardiac Surgery (MINS), Perioperative ischemia, Troponin assay, VISION study, Coronary artery disease

scholarly journals P774 Utility of global longitudinal strain to predict post-operative outcomes in non-cardiac surgery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C J Park ◽  
L S Tan ◽  
P Huang ◽  
P J Tan ◽  
J H J See
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Risk Stratification ◽  
Longitudinal Strain ◽  
Myocardial Injury ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Operative Outcomes ◽  
Lv Dysfunction

Abstract Background Pre-operative echocardiography is performed in selected groups of patients for cardiac risk stratification prior to surgery. Many parameters, including Left Ventricular Ejection Fraction (LVEF), are assessed during echocardiography. While many studies have cited association between low LVEF and poor operative outcomes such as perioperative myocardial infarction or cardiogenic pulmonary edema, LVEF has limitations such as left ventricular (LV) cavity border tracing, geometric assumptions and inter-observer variability. LVEF may also appear normal in the presence of LV hypertrophy and a small LV cavity size. Studies have described the routine use of global longitudinal strain (GLS) as an alternative measure of ventricular function, with GLS having been reported to be a reliable marker in detecting subclinical LV dysfunction. This adds incremental value in predicting myocardial function and in risk stratification. In fact, some studies have documented GLS being a useful preoperative parameter in predicting postoperative LV dysfunction after cardiac valve surgery. Purpose The aim of this study is to determine the value of GLS in predicting post-operative outcomes in patients undergoing non-cardiac surgeries. Methods This was a retrospective study of all patients who had echocardiography performed for a pre-operative indication from February 2017 to October 2017. These patients were screened for those who had normal LVEF, had undergone subsequent non-cardiac surgery, and had post-operative troponins measured. Medical records were traced for baseline demographics, past medical history and echocardiographic features. GLS evaluation was prospectively performed using TOMTEC-ARENA (TOMTEC Imaging Systems GmbH) by assessors blinded to patient outcomes. Outcomes for major adverse cardiovascular events and mortality up to 1 year post surgery were collected. Post-op myocardial injury was defined as a peak Troponin T value of >30 ng/L or a >20% increment from baseline. Results A total of 42 patients were included. 61.9% (n = 26) were male and mean age was 72.3 years. Only 75.6% of patients were fully independent with activities of daily living and mean creatinine was 153.4μmol/L. Mortality at 1 year was 16.7% (n = 7) and 28.6% (n = 12) were deemed to have post-operative myocardial injury. 1-year mortality was associated with a lower GLS (-23.8% vs -19.2%, p = 0.001). However, GLS was not correlated with post-operative myocardial injury or hospital readmissions. In our study population, only a history of past myocardial infarction predicted post-op myocardial injury (58.3% vs 16.7%, p = 0.019). Conclusion Our study did not demonstrate the utility of GLS in predicting post-operative events, but this is likely because of the small sample size with low event rates. Nevertheless, GLS values did correlate with 1-year mortality and could be a marker of frailty and an increased mortality risk.

Ischaemic Preconditioning Reduces Myocardial Injury in Patients Undergoing Cardiac Surgery

1996 ◽  
Vol 91 (s35) ◽  
pp. 19P-19P ◽  
Author(s):  
DP Jenkins ◽  
WB Pugsley ◽  
DM Yellon
Keyword(s):  
Cardiac Surgery ◽  
Myocardial Injury ◽  
Ischaemic Preconditioning

scholarly journals Effects of Volatile versus Total Intravenous Anesthesia on Occurrence of Myocardial Injury after Non-Cardiac Surgery

2019 ◽  
Vol 8 (11) ◽  
pp. 1999 ◽  
Author(s):  
Kwon ◽  
Park ◽  
Lee ◽  
Oh ◽  
Lee ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Myocardial Injury ◽  
Kidney Injury ◽  
High Sensitivity ◽  
Total Intravenous Anesthesia ◽  
P Value ◽  
Type I ◽  
Intravenous Anesthesia ◽  
Remifentanil Infusion ◽  
New Onset

The cardioprotective effects of volatile anesthetics versus total intravenous anesthesia (TIVA) are controversial, especially in patients undergoing non-cardiac surgery. Using current generation high-sensitivity cardiac troponin (hs-cTn), we aimed to evaluate the effect of anesthetics on the occurrence of myocardial injury after non-cardiac surgery (MINS). From February 2010 to December 2016, 3555 patients without preoperative hs-cTn elevation underwent non-cardiac surgery under general anesthesia. Patients were grouped according to anesthetic agent; 659 patients were classified into a propofol-remifentanil total intravenous anesthesia (TIVA) group, and 2896 patients were classified into a volatile group. To balance the use of remifentanil between groups, a balanced group (n = 1622) was generated with patients who received remifentanil infusion in the volatile group, and two separate comparisons were performed (TIVA vs. volatile and TIVA vs. balanced). The primary outcome was occurrence of MINS, defined as rise of hs-cTn I ≥ 0.04 ng/mL within postoperative 48 hours. The secondary outcomes were 30-day mortality, postoperative acute kidney injury (AKI), and adverse events during hospital stay (mortality, type I myocardial infarction (MI), and new-onset arrhythmia). In propensity-matched analyses, the occurrence of MINS was lower in the TIVA group compared to the volatile group (OR 0.642; 95% CI 0.450–0.914; p = 0.014). However, after balancing the use of remifentanil, there was no difference between groups in the risk of MINS (OR 0.832; 95% CI 0.554–1.251; p-value = 0.377). There were no significant associations between the two groups in type 1 MI, new-onset atrial fibrillation, in-hospital and 30-day mortality before and after balancing the use of remifentanil. However, the incidence of postoperative AKI was lower in the TIVA group (OR 0.362; 95% CI 0.194–0.675; p-value = 0.001). After balancing the use of remifentanil, volatile anesthesia and TIVA showed comparable effects on MINS in patients undergoing non-cardiac surgery without preoperative myocardial injury. Further studies are needed on the benefit of remifentanil infusion.

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