scholarly journals Postoperative atrial fibrillation as a risk factor for cardiovascular complications in non-cardiac surgery

2020 ◽  
Vol 19 (4) ◽  
pp. 2540
Author(s):  
O. N. Dzhioeva ◽  
O. M. Drapkina
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Perioperative Complications ◽  
Risk Index ◽  
Clinical Importance ◽  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Improvement Program ◽  
Deliberate Hypotension ◽  
Number Of Patients

Reducing mortality due to cardiovascular complications (CVC) after non-cardiac surgery is one of the priority tasks of modern healthcare. According to the literature data, it is the CVC that are leading cause of perioperative mortality in non-cardiac surgery. Atrial fibrillation (AF) is a common complication after surgery. It is believed that in most cases the AF is potentiated by a combination of factors. It is intraoperative triggers, such as deliberate hypotension, anemia, injury, and pain, that can directly contribute to development of arrhythmia. However, heart rate monitoring after non-cardiac surgery is performed in only a small number of patients, so in most cases, arrhythmias remain unreported. The Revised Cardiac Risk Index (RCRI) and theAmericanCollegeof Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator are the current tools for assessing perioperative cardiovascular risk. Postoperative AF is not included in any CVC risk stratification system. The presented review systematizes the data that postoperative AF is closely associated with perioperative complications and in some cases it may be the only marker of these complications.  It has been shown that AF detection is of great clinical importance in both high-risk patients and, especially, in patients with a low risk of potential complications in non-cardiac surgery.

Introduction and epidemiology

ESC CardioMed ◽  
2018 ◽  
pp. 2637-2639
Author(s):  
Hans Erik Bøtker
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Surgical Procedure ◽  
Congenital Heart ◽  
Perioperative Complications ◽  
Left Ventricular ◽  
Medical Attention ◽  
Cardiac Complications ◽  
Postoperative Risk ◽  
Number Of Patients

Perioperative complications during non-cardiac surgery depend on the condition of the patient prior to surgery, the prevalence of co-morbidities, and the magnitude, duration, and timing of the surgical procedure. Cardiac complications most frequently arise in patients with documented or asymptomatic ischaemic heart disease, left ventricular dysfunction, valvular heart disease, and arrhythmias, including the presence of a pacemaker or implantable cardioverter defibrillator, when they undergo surgical procedures that are associated with prolonged haemodynamic and cardiac stress. The increasing ageing of the population has a major impact on perioperative patient management. The number of elderly patients with co-morbidities undergoing surgery increases and new surgical and anaesthesia techniques allow surgeons to operate on patients who were previously declined. In addition, the life expectancy of children with congenital heart disease has improved. Hence, this population increasingly seeks medical attention for other illnesses, adding a rising number of patients who will undergo non-cardiac surgeries. Reduction of peri- and postoperative risk in relation to non-cardiac surgery requires a practical, stepwise evaluation of the patient that integrates clinical risk factors and test results with the estimated stress of the planned surgical procedure.

scholarly journals THE IMPORTANCE OF THE DIASTOLIC DYSFUNCTION IN THE CARDIOVASCULAR RISK STRATIFICATION OF NON-CARDIAC SURGICAL INTERVENTION

2018 ◽  
Vol 5 (5) ◽  
pp. 18-25
Author(s):  
O. N. Dzhioeva
Keyword(s):  
Risk Stratification ◽  
Diastolic Dysfunction ◽  
Perioperative Complications ◽  
Practical Interest ◽  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Cardiovascular Risks ◽  
Cardiac Events ◽  
Surgical Interventions ◽  
Negative Prognostic Factor

The article is an overview of foreign data on the evaluation of diastolic function disorders as a predictor of cardiovascular complications in non-cardiac surgical interventions. This problem is of significant practical interest, since in modern recommendations on the stratification of cardiac risk of perioperative complications, diastolic dysfunction is not identified as a negative prognostic factor. Although current guidelines on perioperative assessment of cardiovascular risks in extracardiac surgery do not evaluate diastolic dysfunction as a risk factor, more and more data indicate a higher incidence of serious adverse cardiac events, a longer hospital stay in patients with diastolic CHF. The article presents modern evidence supporting the need to include diastolic dysfunction in the risk stratification of non-cardiac surgical interventions.

scholarly journals Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

2021 ◽  
Vol 18 (4) ◽  
pp. 62-72
Author(s):  
D. A. Sokolov ◽  
P. A. Lyuboshevsky ◽  
I. N. Staroverov ◽  
I. A. Kozlov
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Surgery ◽  
Chronic Heart Failure ◽  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Cardiac Events ◽  
Risk Indices ◽  
Medium Risk ◽  
Potential Risk Factors

The objective: to analyze the incidence and spectrum of cardiovascular complications within 12 months after noncardiac surgery, as well as to assess the association of preoperative values of various cardiac risk indices (CRI) and other potential risk factors with the actual development of complications.Subjects and Methods. We analyzed data of medical records and telephone interviews of 141 patients aged 65 [60-71] years who had undergone non-cardiac surgery a year before the interview The operations were low risk in 13.5% of observations, medium risk in 64.5%, and high risk in 22%. A retrospective calculation of the Revised CRI (RCRI), Individual CRI (Khoronenko CRI), and the American College of Surgeons Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA) was performed.Results. Cardiac events (myocardial infarction, decompensation of chronic heart failure, new arrhythmias, stroke, and/or the need to prescribe or escalate the dose of cardiovascular drugs and/or hospitalization for cardiac indications, and/or death from cardiovascular diseases) within 12 months after elective noncardiac surgeries were detected in 27.7% of cases, and in 2.1% of patient's death occurred due to cardiac disorders. Predictors of cardiac events were concomitant ischemic heart disease (OR = 2.777; 95% CI 1.286-5.966; p = 0.0093) and chronic heart failure (OR = 2.900; 95% CI 1.224-6.869; p = 0, 0155), RCRI (OR = 1.886; 95% CI 1.2-8-2.944; p = 0.005), Khoronenko CRI (OR = 3254.3; 95% CI 64.33-164,638; p = 0.0001), MICA (OR = 1.628; 95% CI 1.156-2.292; p = 0.005), creatininemia on the first postoperative day (OR = 1.023; 95% CI 1.010-1.061; p = 0.005), and propensity for bradycardia during surgery (OR = 0.945; 95% CI 0.908-0.983; p = 0.005). Combined analysis of Khoronenko's CRI and postoperative creatininemia provided a very good model: area under the ROC-curve - 0.823 (95% CI 0.728-0.641; p = 0.0002).Conclusion. All studied CRIs can be used to predict posthospital cardiac events; however, the most promising is a joint assessment of Khoronenko's CRI and postoperative creatinemia.

scholarly journals An Elderly Comorbid Patient with Atrial Fibrillation: What is Important to Know and What Should be Considered When Prescribing Anticoagulants?

2020 ◽  
Vol 16 (6) ◽  
pp. 1031-1038
Author(s):  
T. V. Pavlova
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Randomized Clinical Trials ◽  
Simple Algorithm ◽  
Cardiovascular Complications ◽  
Efficacy And Safety ◽  
Risk Of Bleeding ◽  
Number Of Patients

Anticoagulant therapy in elderly patients with atrial fibrillation and concomitant diseases is often the challenge for clinicians. The high risk of stroke is inherent in atrial fibrillation, and it increases when combined with coronary heart disease and chronic kidney disease. On the other hand, the comorbidity increases the risk of bleeding. Older age is also the risk factor of thrombotic and hemorrhagic complications. As a consequence, the choice of specific anticoagulant should be based on a solid evidences, obtained both from randomized clinical trials and from daily clinical practice. In the ROCKET AF trail the direct oral anticoagulant rivaroxaban showed a tendency to reduce the risk of thromboembolism by 20% compared with warfarin in the patients aged 75 years and older. The safety of rivaroxaban has been evaluated in the XANTUS POOLED program. According to the follow-up results for 12 months, more than 96% of patients didn't have any adverse event, and the number of patients with major bleeding was 1.5%. Several meta-analyzes reported a reduction of cardiovascular complications in patients treated by rivaroxaban. In the ROCKET AF trail, a “renal” dose of rivaroxaban (15 mg OD) was studied in patients with chronic kidney disease. The efficacy and safety of rivaroxaban were validated in this patients, and a simple algorithm for selecting the dose of this drug in patients with chronic kidney disease was provided. 

scholarly journals Radiofrequency ablation as a concomitant procedure for the treatment of atrial fibrillation during cardiac surgery

2019 ◽  
Vol 8 (2) ◽  
pp. 108-115
Author(s):  
Kaushal K Tiwari ◽  
Tommaso Gasbarri ◽  
Stefano Bevilacqua ◽  
Manish Jawarkar ◽  
Mausam Shah ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Radiofrequency Ablation ◽  
Maze Procedure ◽  
Pubmed Central ◽  
Concomitant Procedure ◽  
Cardiac Procedures ◽  
Number Of Patients ◽  
Study Type ◽  
The Impact

Atrial fibrillation is the most common type of arrhythmia with increasing burden for stroke and thromboembolic events. Medical treatment of atrial fibrillation has not shown promising results, so alternative method of treatment is emerging out. Cox-Maze procedure has been used for decades for the treatment of atrial fibrillation. Surgical treatment of atrial fibrillation with traditional Cox-Maze procedure is a complex and technically challenging procedure limiting its use in clinical practice. Recently, radiofrequency ablation is being used as a modification of Cox-Maze procedure. However, its effect in the treatment of atrial fibrillation in not reported uniformly and in large number of patients. Therefore, our aim of study was to assess the impact of concomitant radiofrequency ablation in the treatment of atrial fibrillation during cardiac surgery. We performed literature review on PubMed Central to evaluate effect of concomitant radiofrequency ablation for atrial fibrillation treatment. About 303 papers were found using the reported search, of which 15 represented suitable to fulfill our query. The authors, date, patient group, study type, relevant outcomes and results of these papers are tabulated. We conclude that radiofrequency ablation surgery of left atrium at the time of other cardiac procedures is a comparatively straightforward procedure with satisfactory freedom from atrial fibrillation, acceptable morbidity, mortality, and minor procedure related complications. Careful patients selection by sticking to the - Rule of 5, i.e. left atrial diameter less than 55 mm and atrial fibrillation duration no more than five years, is recommended to optimize the result of atrial fibrillation surgery.

Abstract 15582: Patterns of Statin Initiation in Patients Undergoing Intermediate to High Risk Non-Cardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Elisabetta Patorno ◽  
Shirley Wang ◽  
Sebastian Schneeweiss ◽  
Jun Liu ◽  
Brian Bateman
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Vascular Surgery ◽  
Elective Surgery ◽  
Risk Index ◽  
Cardiac Risk ◽  
Cardiac Events ◽  
Initiation Rate ◽  
Cardiac Risk Index ◽  
Recent Estimate

Background: Starting from early to mid 2000s a growing body of literature has been produced on the potential role of statins in reducing perioperative cardiac events in patients undergoing non-cardiac surgery. However, evidence remains inconsistent and little is known regarding the use of perioperative statins in clinical practice. Objectives: To examine pattern of statin initiation among patients undergoing non-cardiac elective surgery in the US. Methods: Using data from a large US healthcare insurer, we identified patients ≥18 years who underwent moderate- to high-risk non-cardiac elective surgery and initiated statins within 30-days before surgery. We assessed trends of statin initiation over time and predictors of initiation. To ensure statin initiation was precipitated by non-cardiac surgery vs. alternative indications, we also assessed the effect of temporal proximity to surgery on initiation in a matched analysis. Results: Of 460,154 patients undergoing surgery between 2003-2012, 5,628 (1.2%) initiated a statin before surgery. Initiation rate increased from 0.8% in 2003 to 1.5% in 2012 (p = .0004). The increase was more pronounced among patients with revised cardiac risk index (RCRI) score ≥2 and patients undergoing vascular surgery, with initiation rates equal to 7.2% and 14.9% respectively by the end of 2012. Proximity to surgery was predictive of statin initiation (p < .0001). Significant predictors of initiation were older age, male sex, revised cardiac risk index (RCRI) score ≥1, vascular or orthopedic surgery. At the most recent estimate, patients undergoing vascular surgery and with a RCRI score ≥2 had initiation rates equal to 19.9%. Conclusions: The rate of statin initiation progressively increased from 2003 to 2012, particularly among patients with higher RCRI score and undergoing major vascular surgery. Research is needed to further define the risks and benefits of initiation of statins prior to surgery.

scholarly journals Preoperative assessment of cardiovascular risk in patients undergoing noncardiac surgery: the Orion study

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Giampaolo Scorcu ◽  
Annarita Pilleri ◽  
Paolo Contu ◽  
Pompilio Faggiano ◽  
Roberto Floris ◽  
...  
Keyword(s):  
Risk Score ◽  
Risk Index ◽  
Preoperative Assessment ◽  
Predictive Performance ◽  
Roc Curves ◽  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Noncardiac Surgery ◽  
Derivation Cohort ◽  
Risk Indices

In patients undergoing noncardiac surgery risk indices can estimate patients’ perioperative risk of major cardiovascular complications. The indexes currently in use were derived from observational studies that are now outdated with respect to the current clinical context. We undertook a prospective, observational, cohort study to derive, validate, and compare a new risk index with established risk indices. We evaluated 7335 patients (mean age 63±13 years) who underwent noncardiac surgery. Based on prospective data analysis of 4600 patients (derivation cohort) we developed an Updated Cardiac Risk Score (UCRS), and validated the risk score on 2735 patients (validation cohort). Four variables (i.e. the UCRS) were significantly associated with the risk of a major perioperative cardiovascular events: high-risk surgery, preoperative estimate glomerular filtration rate <30 ml/min/1.73 m2, age ≥75 years, and history of heart failure. Based on the UCRS we created risk classes 1,2,3 and 4 and their corresponding 30-day risk of a major cardiovascular complication was 0.8% [95% confidence interval (CI) 0.5-1.7], 2.5 (95% CI 1.6-5.6), 8.7 (95% CI 5.2-18.9) and 27.2 (95% CI 11.8-50.3), respectively. No significant differences were found between the derivation and validation cohorts. Receiver operating characteristic (ROC) curves demonstrate a high predictive performance of the new index, with greater power to discriminate between the various classes of risk than the indexes currently used. The high predictive performance and simplicity of the UCRS make it suitable for wide-scale use in preoperative cardiac risk assessment of patients undergoing noncardiac surgery.

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