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.

Risk reduction strategies: coronary revascularization before non-cardiac surgery

ESC CardioMed ◽  
2018 ◽  
pp. 2659-2663
Author(s):  
Fabio Rigamonti ◽  
Marco Roffi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Surgery ◽  
Myocardial Revascularization ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Metal Stents ◽  
Percutaneous Coronary ◽  
Reduction Strategies ◽  
Drug Eluting

An individualized, stepwise patient evaluation based on the degree of urgency of non-cardiac surgery, functional capacity, clinical presentation, and estimated cardiovascular stress related to surgery is recommended in order to assess the perioperative cardiovascular risk and optimize management. Myocardial ischaemia in the context of non-cardiac surgery may be related to acute coronary syndromes secondary to coronary plaque rupture or prolonged myocardial oxygen supply–demand imbalance. Randomized controlled trials have failed to show a benefit of routine preoperative prophylactic myocardial revascularization. Preoperative coronary angiography and, if appropriate, myocardial revascularization may be considered before high-risk surgery depending on symptom status and extent of ischaemia on non-invasive imaging. In patients requiring percutaneous coronary intervention, guidelines recommend new-generation drug-eluting stents over bare-metal stents, though randomized data are absent. While the minimal delay for a safe surgery following drug-eluting stent implantation remains to be defined, a time window of 5–6 weeks between percutaneous coronary intervention and surgery appears to be adequate in patients who cannot wait longer.

scholarly journals Colchicine for the Prevention of Myocardial Injury Following Elective PCI: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Naser Aslanabadi ◽  
Sajad Khiali ◽  
Saeid Joudi ◽  
Milad Mamdouhi ◽  
Taher Entezari-Maleki
Keyword(s):  
Clinical Trial ◽  
Myocardial Injury ◽  
Randomized Clinical Trials ◽  
Troponin I ◽  
Intervention Group ◽  
Myocardial Damage ◽  
Coronary Intervention ◽  
Elective Percutaneous Coronary Intervention ◽  
Mean Differences ◽  
The Impact

Purpose: Considering the potential benefits of colchicine in coronary artery diseases, we aimed to carry out the present study to assess the impact of colchicine in the prevention of myocardial injury following elective percutaneous coronary intervention (PCI). Methods: A randomized, single-blinded, clinical trial was carried out on 102 patients undergoing elective PCI. All patients received the standard treatment prior to performing PCI. Moreover, the intervention group received 1, 0.5, 0.5 mg colchicine 12 to 18 hours before, 30-60 min before, and 12 hours after PCI, respectively. Serum concentrations of cardiac troponin I (cTnI) were measured before, 8, and 24 hours after the procedure to assess myocardial damage during PCI. Results: There were no significant differences in cTnI levels at baseline (P = 0.839), 8 (P = 0.729), and 24 hours (P = 0.398) after PCI between the intervention and the control groups. Likewise, no significant differences were seen regarding the mean differences of cTnI at baseline and 8 hours (P =0.190), at baseline and 24 hours (P = 0.780), and 8 and 24 hours after PCI (P = 0.680) in both groups. Conclusion: The study did not support the potential benefit of colchicine in the prevention of myocardial injury following elective PCI. Conducting well-designed randomized clinical trials with adequate sample size is recommended.

A risk assessment score for patients with end-stage renal failure undergoing cardiac surgery

2006 ◽  
Vol 54 (S 1) ◽  
Author(s):  
T Krabatsch ◽  
M Bechtel ◽  
C Detter ◽  
T Fischlein ◽  
FC Riess ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Renal Failure ◽  
Cardiac Surgery ◽  
End Stage Renal Failure ◽  
Assessment Score ◽  
End Stage

Pregnancy-Related Cardiovascular Complications: Case Presentation and Review of Literature

2016 ◽  
Vol 19 (5) ◽  
pp. E248-E254 ◽  
Author(s):  
Hasan Baki Altinsoy ◽  
Ozkan Alatas ◽  
Salih Colak ◽  
Hakan Atalay ◽  
Omer Faruk Dogan
Keyword(s):  
Cardiac Surgery ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Median Time ◽  
Artery Bypass ◽  
Prosthetic Heart Valve ◽  
Cardiovascular Complications ◽  
Time To Diagnosis ◽  
Valve Thrombosis ◽  
Placental Blood

Background: Cardiovascular complications that can cause severe catastrophic outcomes for both the mother and the fetus are rarely seen during pregnancy. Time to diagnosis is often delayed by a low degree of suspicion and atypical presentation. We report surgical strategies in three pregnant women with cardiovascular complications. Methods: A retrospective search from 2009 to 2016 identified three pregnant women who underwent urgent cardiac surgery. We used extracorporeal circulation (ECC) without cesarean section with careful follow-up of the fetuses during the perioperative and postoperative period. We used levosimendan as a potent inodilator in all patients to increase feto-placental blood flow and fetal heart rhythm.Results: Median time to diagnosis was 23.8 h (range 11.7-120 h) and median time from diagnosis to arrival in the operating theater was 9.8 h (range 7.4-19.8 h). One patient with prosthetic heart valve thrombosis underwent concomitant cesarean section prior to cardiac surgery. In a young pregnant woman who had spontaneous dissection of the left anterior descending artery, on-pump beating heart coronary artery bypass grafting was performed without cross clamping. Two and three months after surgery, cesarean sections were performed without any complication in two pregnant women.Conclusion: Because unusual cardiovascular complications are the main cause of maternal and/or fetus death during pregnancy, prompt and exact diagnosis is very important. Life-saving surgical strategy with the help of appropriate teams are necessary to optimize outcome for both mother and baby.

The Role of Revascularisation in Patients Undergoing Non-cardiac Surgery

2010 ◽  
Vol 5 (1) ◽  
pp. 104
Author(s):  
Daniel S Menees ◽  
Eric R Bates ◽  
◽  
Keyword(s):  
Cardiac Surgery ◽  
Prediction Models ◽  
Cardiovascular Complications ◽  
Weight Of Evidence ◽  
Beta Blockade ◽  
Cardiac Morbidity ◽  
Increased Risk ◽  
Reduction Strategies ◽  
Artery Disease ◽  
Risk Reduction Strategies

Coronary artery disease (CAD) affects millions of US citizens. As the population ages, an increasing number of people with CAD are undergoing non-cardiac surgery and face significant peri-operative cardiac morbidity and mortality. Risk-prediction models can be used to help identify those patients at increased risk of peri-operative cardiovascular complications. Risk-reduction strategies utilising pharmacotherapy with beta blockade and statins have shown the most promise. Importantly, the benefit of prophylactic coronary revascularisation has not been demonstrated. The weight of evidence suggests reserving either percutaneous or surgical revascularisation in the pre-operative setting for those patients who would otherwise meet independent revascularisation criteria.

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

scholarly journals COVID-19 related mortality in post-operative cardiac surgical patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Azhar Hussain ◽  
Amina Khalil ◽  
Priyanka Kolvekar ◽  
Prity Gupta ◽  
Shyamsunder Kolvekar
Keyword(s):  
Cardiac Surgery ◽  
Long Term Outcomes ◽  
Case Presentation ◽  
Elective Cardiac Surgery ◽  
The United Kingdom ◽  
Global Pandemic ◽  
Cardiac Operations ◽  
Related Mortality

Abstract Background COVID-19 has caused a global pandemic of unprecedented proportions. Elective cardiac surgery has been universally postponed with only urgent and emergency cardiac operations being performed. The National Health Service in the United Kingdom introduced national measures to conserve intensive care beds and significantly limit elective activity shortly after lockdown. Case presentation We report two cases of early post-operative mortality secondary to COVID-19 infection immediately prior to the implementation of these widespread measures. Conclusion The role of cardiac surgery in the presence of COVID-19 is still very unpredictable and further studies on both short term and long term outcomes are warranted.

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