Assessment and reduction of cardiac complications risk in non-cardiac operations: whether there are differences between European and American guidelines in 2014?

2015 ◽  
pp. 5-18 ◽  
Author(s):  
Alexey Sumin ◽  
◽  
Dmitriy Sumin ◽  
Keyword(s):  
Cardiac Complications ◽  
Cardiac Operations

scholarly journals Actual Issues of the Cardiac Complications Risk Assessment and Correction in Non-Cardiac Surgery

2020 ◽  
Vol 16 (5) ◽  
pp. 749-758
Author(s):  
A. N. Sumin
Keyword(s):  
Risk Assessment ◽  
Cardiac Surgery ◽  
Randomized Clinical Trials ◽  
Dynamic Assessment ◽  
Myocardial Revascularization ◽  
Myocardial Damage ◽  
Coronary Intervention ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Cardiac Operations

Worldwide, more than 200 million non-cardiac surgeries are performed annually, and this number is constantly increasing; cardiac complications are the leading cause of death in such surgeries. So, in a multicenter study conducted in 27 countries, cardiovascular complications were present in 68% of cases of death in the postoperative period. Registers of recent years have shown that the number of such complications remains high, for example, with a dynamic assessment of troponins, perioperative myocardial damage was detected in 13-18% of cases. This review provides a critical analysis of the step-by-step algorithm for assessing cardiac risk of non-cardiac operations considering the emergence of new publications on this topic. The review discusses new data on risk assessment scales, functional state assessment, the use of non-invasive tests, biomarkers, the role of preventive myocardial revascularization in the preoperative period, and drug therapy. The issues of non-cardiac operations after percutaneous coronary intervention, perioperative myocardial damage are considered separately. The review emphasizes the difficulties in obtaining evidence, conducting randomized clinical trials in this section of medicine, which do not allow obtaining unambiguous conclusions in most cases and lead to inconsistencies and ambiguities in the recommendations of various expert groups. This review will help practitioners navigate this issue and help to use the optimal diagnostic and treatment strategy before performing non-cardiac surgery.

Carotid endarterectomy following thrombolysis for acute ischaemic stroke

VASA ◽  
2017 ◽  
Vol 46 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Naz Ahmed ◽  
Damian Kelleher ◽  
Manmohan Madan ◽  
Sarita Sochart ◽  
George A. Antoniou
Keyword(s):  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Cardiac Complications ◽  
High Dependency ◽  
Low Incidence

Abstract. Background: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. Patients and methods: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points. Results: Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3–50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1–33 days). Conclusions: Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke.

High NIHSS scores after stroke onset suggest increased risk of sympathetic cardiac complications

2009 ◽  
Vol 36 (S 02) ◽  
Author(s):  
MJ Hilz ◽  
S Schwab ◽  
P De Fina ◽  
H Marthol
Keyword(s):  
Stroke Onset ◽  
Cardiac Complications ◽  
Increased Risk

Homozygous resistance to thyroid hormone: can cardiac complications be prevented?

2013 ◽  
pp. 1-1
Author(s):  
Carla Moran ◽  
Amal AlJohani ◽  
Odelia Rajanayagam ◽  
David Halsall ◽  
Abdelhadi Habeb ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Cardiac Complications ◽  
Resistance To Thyroid Hormone

Chylopericardium following Atrial Septal Defect Repair: Case Report

2005 ◽  
Vol 8 (1) ◽  
pp. 23 ◽  
Author(s):  
Sanjay Kumar ◽  
Bharati Sinha
Keyword(s):  
Case Report ◽  
Atrial Septal Defect ◽  
Cardiac Tamponade ◽  
Unusual Case ◽  
Septal Defect ◽  
Clinical Course ◽  
Defect Repair ◽  
Cardiac Operations

Chylopericardium after intrapericardial cardiac operations is extremely rare. We present an unusual case of postoperative chylopericardium with cardiac tamponade following atrial septal defect repair, and we comment on the clinical course and treatment.

Cardiac complications during DLBCL treatment using R-CHOP

Oncoreview ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Barbara Sosnowska-Pasiarska ◽  
Paweł Zgódka ◽  
Paulina Steckiewicz ◽  
Marcin Pasiarski
Keyword(s):  
Cardiac Complications

Estimation of the Safety of Intraoperative Fluid Therapy during Great Abdominal Surgery in Patients with Coronary Heart Disease

2020 ◽  
Vol 5 (5) ◽  
pp. 158-163
Author(s):  
V. I. Lysenko ◽  
◽  
E. A. Karpenko ◽  
Ya. V. Morozova
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Fluid Therapy ◽  
Troponin I ◽  
Significant Proportion ◽  
Myocardial Damage ◽  
Enzyme Linked Immunosorbent Assay ◽  
Cardiac Complications ◽  
Fluid Regimen

The study of intraoperative fluid therapy tactics has been of great interest over the past few years, especially in people with concomitant coronary heart disease, as they make up a significant proportion of all surgical patients. The purpose of our study was to assess the risk of intraoperative myocardial damage in patients with concomitant coronary heart disease depending on the fluid regimen used based on monitoring of hemodynamic parameters, electrocardiogram and biomarkers of myocardial damage. Material and methods. The study involved 89 patients, who were divided into two groups depending on the tactics of intraoperative fluid therapy – restrictive and liberal. In order to detect cardiac complications at different stages, we assessed biomarkers of myocardial damage Troponin I, NT-proBNP by solid-phase enzyme-linked immunosorbent assay (ELISA). Results and discussion. Analysis of the obtained data showed that MINS (myocardial injury in noncardiac surgery) incidents were diagnosed in 5 patients (11.1%) in the first group and in 6 patients (13.6%) in the second. In patients of both groups there was an increase in NT-proBNP in the dynamics at all stages, and in the 2nd group, with a liberal regimen of intraoperative fluid therapy, it was more pronounced. It should be noted that the obtained values of NT-proBNP in all patients did not differ significantly from those allowed for this age group; such dynamics of NT-proBNP may indicate a relative risk of complications of liberal fluid therapy in patients with baseline heart failure. One of the important points when choosing the mode of fluid therapy in patients with high cardiac risk is the assessment of the initial volemic status and careful monitoring of water balance in the perioperative period with the desire for "zero" balance. The obtained dynamics of laboratory markers of myocardial damage indicates that in patients with a significant reduction in cardiac reserves compensated for heart failure, a restrictive fluid regimen is preferable, which is also confirmed by slight changes in the concentration of biomarkers. Conclusion. Thus, the study demonstrated the relative safety of selected fluid regimens in patients with concomitant coronary heart disease without signs of congestive heart failure

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