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Perioperative cardiovascular evaluation

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https://www.readbyqxmd.com/read/29753563/critical-appraisal-of-the-2018-acc-scientific-sessions-late-breaking-trials-from-a-statistician-s-perspective
#1
REVIEW
Stuart J Pocock, Tim J Collier
The late-breaking clinical trials presentations at the American College of Cardiology Scientific Sessions in March 2018 are an important contribution to the field of cardiology. This paper presents a constructive critical appraisal of 7 key studies: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab), VEST (Vest Prevention of Early Sudden Death Trial), SECURE-PCI (Statins Evaluation in Coronary Procedures and Revascularization), TREAT (Ticagrelor in Patients with ST-Elevation Myocardial Infarction treated with Pharmacological Thrombolysis), POISE (PeriOperative ISchemic Evaluation), SMART-DATE (Safety of 6-Month Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome), and CVD-REAL 2 (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors)...
May 7, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29749243/the-predictive-value-of-risk-indices-for-cardiac-complications-in-living-donor-liver-transplantation
#2
I P Canbolat, Y Erdogan, G Adali, O Kaplan, M Dayangac, Y Yuzer, Y Tokat
BACKGROUND AND AIMS: The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) risk tool and Revised Cardiac Risk Index (RCRI) are recommended tools for cardiovascular assessment before non-cardiac surgery to predict early postoperative cardiac morbidity and mortality. Their predictive value for postoperative cardiovascular morbidity and mortality after liver transplantation is unknown. We aimed to evaluate the validity of these two risk tools to predict early (30-day) cardiovascular complications and in-hospital all-cause mortality...
2018: Bratislavské Lekárske Listy
https://www.readbyqxmd.com/read/29710128/association-of-timing-of-aortic-valve-replacement-surgery-after-stroke-with-risk-of-recurrent-stroke-and-mortality
#3
Charlotte Andreasen, Mads Emil Jørgensen, Gunnar H Gislason, Andreas Martinsson, Robert D Sanders, Jawdat Abdulla, Per Føge Jensen, Christian Torp-Pedersen, Lars Køber, Charlotte Andersson
Importance: Timing of surgical aortic valve replacement (SAVR) in patients with aortic valve stenosis and previous stroke for the risk of recurrent stroke is insufficiently investigated. Objective: To evaluate the association of time elapsed between previous stroke and SAVR with the risk of recurrent perioperative stroke, major adverse cardiovascular events (MACE), and mortality among patients with aortic valve stenosis. Design, Setting, and Participants: This cohort study using data from Danish administrative registries included all patients with aortic valve stenosis older than 18 years who underwent SAVR between 1996 and 2014 (n = 14 030)...
April 25, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29702994/a-case-report-regarding-general-anesthesia-management-of-a-patient-with-pulmonary-vein-stenosis-that-underwent-balloon-dilatation-and-stent-implantation
#4
Fangzhou Li, Guoyan Qiao, Peng Liang, Jin Liu
RATIONALE: Pulmonary vein stenosis (PVS) is a rare cardiovascular deformity that can lead to high mortality if left untreated. Patients frequently experience multiple complications such as hemoptysis, pulmonary hypertension, bronchial venous rupture and cardiac insufficiency. Currently, pulmonary vein stenosis balloon dilatation (stent implantation) is the only treatment, and this can be performed under local or general anesthesia. However, a case report on the general anesthesia management of PVS has not been previously reported...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29693945/anestheic-management-of-a-patient-with-intravenous-leiomyomatosis-extending-into-the-right-atrium
#5
Moe Kodama, Maiko Honma, Keisuke Shibukawa, Yasuhiro Kamada, Shoji Yanagiya, Michiaki Yamakage
Intravenous leiomyomatosis (IVL) is a condition in which leiomyoma originating from uterine myoma or intrauterine venous walls develops intravenously. A single-stage operation was planned by the departments of gynecology and cardiovascular surgery for a patient in which the IVL was extended across the tricuspid valve. It was possible to safely perform perioperative care with continued evaluation of the tumor position and intravascular volume through the use of transesophageal echocardiography (TEE). TEE can be useful in the intraoperative care of patients with intracardiac tumor extension as in this case...
May 2017: Masui. the Japanese Journal of Anesthesiology
https://www.readbyqxmd.com/read/29682533/bilateral-hip-arthroplasty-when-is-it-safe-to-operate-the-second-hip-a-systematic-review
#6
REVIEW
Meilyn Muskus, Jorge Rojas, Camilo Gutiérrez, Juan Guio, Guillermo Bonilla, Adolfo Llinás
Introduction: Patients with degenerative hip disease frequently present with bilateral involvement that requires surgical management. The main goal when treating these patients is to achieve the maximum efficiency without increasing risk of perioperative complications; therefore, the decision regarding the best moment to operate the second hip becomes relevant. Although studies have addressed this topic, whether a simultaneous or staged surgery should be performed remains controversial...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29681567/recovery-of-endothelial-function-after-minor-to-moderate-surgery-is-impaired-by-diabetes-mellitus-obesity-hyperuricemia-and-sevoflurane-based-anesthesia
#7
Sachi Ohno, Atsushi Kohjitani, Masaaki Miyata, Akina Tohya, Kaoru Yamashita, Teruto Hashiguchi, Mitsuru Ohishi, Mitsutaka Sugimura
Endothelial dysfunction is observed in several cardiovascular diseases, where endothelium-dependent vasodilation is impaired by oxidative stress. However, the time course of endothelial function during the perioperative period of a minor-to-moderate surgery, and the effects of atherosclerotic risk factors and employed general anesthetics on recovery of endothelial function, are unknown. Endothelial function of 30 patients was evaluated as the reactive hyperemia index (RHI) of reactive hyperemia peripheral arterial tonometry...
April 20, 2018: International Heart Journal
https://www.readbyqxmd.com/read/29676780/retrospective-evaluation-of-a-restrictive-transfusion-strategy-in-older-adults-with-hip-fracture
#8
Lorene Zerah, Lucile Dourthe, Judith Cohen-Bittan, Marc Verny, Mathieu Raux, Anthony Mézière, Frédéric Khiami, Cendrine Tourette, Christian Neri, Yannick Le Manach, Bruno Riou, Hélène Vallet, Jacques Boddaert
OBJECTIVES: To compare the association between a restrictive transfusion strategy and cardiovascular complications during hospitalization for hip fracture with the association between a liberal transfusion strategy and cardiovascular complications, accounting for all transfusions from the emergency department to postacute rehabilitation settings. DESIGN: Retrospective study. SETTING: Perioperative geriatric care unit. PARTICIPANTS: All individuals aged 70 and older admitted to the emergency department for hip fracture and hospitalized in our perioperative geriatric care unit (N=667; n=193 in the liberal transfusion group, n=474 in the restrictive transfusion group) from July 2009 to April 2016...
April 20, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29658678/emergency-surgery-for-bowel-obstruction-in-extremely-aged-patients
#9
Alberto Oldani, Valentina Gentile, Chiara Magaton, Marcello Calabrò, Fabio Maroso, Lidia Ravizzini, Giacomo Deiro, Maurizio Amato, Sergio Gentilli
BACKGROUND: As a result of the increasing of life expectancy, the incidence of pathologies that can lead to operation for bowel obstruction is also increasing. Comorbidities and reduced physiological reserve can decrease elderly patients' ability to tolerate operations especially in an emergency context. We retrospectively evaluated the treatment and outcomes of a cohort of patients aged more than 85 years who underwent emergency surgery for intestinal occlusion. METHODS: 278 patients who were admitted to our Institution and operated for acute bowel obstruction have been included in our study...
April 13, 2018: Minerva Chirurgica
https://www.readbyqxmd.com/read/29618572/influence-of-diabetes-on-trends-in-perioperative-cardiovascular-events
#10
Jonathan D Newman, Tanya Wilcox, Nathaniel R Smilowitz, Jeffrey S Berger
OBJECTIVE: Patients undergoing noncardiac surgery frequently have diabetes mellitus (DM) and an elevated risk of cardiovascular disease. It is unknown whether temporal declines in the frequency of perioperative major adverse cardiovascular and cerebrovascular events (MACCEs) apply to patients with DM. RESEARCH DESIGN AND METHODS: Patients ≥45 years of age who underwent noncardiac surgery from January 2004 to December 2013 were identified using the U.S. National Inpatient Sample...
April 4, 2018: Diabetes Care
https://www.readbyqxmd.com/read/29610608/pharmacotherapy-evaluation-and-utilization-in-coronary-artery-bypass-grafting-patients-in-kosovo-during-the-period-2016-2017
#11
Armond Daci, Adnan Bozalija, Raif Cavolli, Rame Alaj, Giangiacomo Beretta, Shaip Krasniqi
BACKGROUND: Coronary Artery Bypass Grafting (CABG) is realised in patients with critical or advanced disease of coronary arteries. There are different pharmacotherapeutic approaches which are used as management, treatment and preventive therapy in cardiovascular disease or related comorbidities. Performing a successful surgery, pharmacotherapy, and increase of bypass patency rate remains a serious challenge. AIM: This study aims to analyse the patient characteristics undergoing CABG and evaluation of their drug utilisation rate and daily dosages in the perioperative period...
March 15, 2018: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/29598850/evaluation-of-risk-factors-for-complications-after-bariatric-surgery
#12
D Quilliot, M-A Sirveaux, C Nomine-Criqui, T Fouquet, N Reibel, L Brunaud
The decision to perform a bariatric surgical procedure, the conclusion of a clinical pathway in which management is individually adapted to each patient, is taken after multidisciplinary consultation. Paradoxically, the patients who would most benefit from surgery are also those who have the highest operative risk. In practice, predictive factors of mortality and severe postoperative complications (Clavien-Dindo>III) must be used to evaluate the benefit/risk ratio most objectively. The main risk factors are age, male gender, body mass index, obstructive sleep apnea syndrome, insulin resistance and diabetes, tobacco abuse, cardiovascular disease, ability to lose weight before surgery, hypoalbuminemia and functional disability...
March 26, 2018: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/29559052/effect-of-gender-on-postoperative-morbidity-and-mortality-outcomes-a-retrospective-cohort-study
#13
Muhyeddine Al-Taki, Hamdi G Sukkarieh, Jamal J Hoballah, Sarah F Jamali, Mohamad Habbal, Karim Z Masrouha, Racha Abi-Melhem, Hani Tamim
Full extent of gender differences on postoperative outcomes has never been studied on large scale, specifically postoperative complications. This study aims to assess the effect of gender on 30-day morbidity and mortality after major surgery. A retrospective cohort study was carried out using data of patients undergoing major surgeries from the American College of Surgeons' National Surgical Quality Improvement Program database between 2008 and 2011. Demographics, pre- and perioperative risk factors, as well as 30-day morbidities, both overall and specific, were reviewed...
March 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29556907/perioperative-management-of-patients-with-inflammatory-rheumatic-diseases-undergoing-major-orthopaedic-surgery-a-practical-overview
#14
REVIEW
Roberta Gualtierotti, Marco Parisi, Francesca Ingegnoli
Patients with inflammatory rheumatic diseases often need orthopaedic surgery due to joint involvement. Total hip replacement and total knee replacement are frequent surgical procedures in these patients. Due to the complexity of the inflammatory rheumatic diseases, the perioperative management of these patients must envisage a multidisciplinary approach. The frequent association with extraarticular comorbidities must be considered when evaluating perioperative risk of the patient and should guide the clinician in the decision-making process...
March 20, 2018: Advances in Therapy
https://www.readbyqxmd.com/read/29533470/perioperative-beta-blockers-for-preventing-surgery-related-mortality-and-morbidity
#15
REVIEW
Hermann Blessberger, Juergen Kammler, Hans Domanovits, Oliver Schlager, Brigitte Wildner, Danyel Azar, Martin Schillinger, Franz Wiesbauer, Clemens Steinwender
BACKGROUND: Randomized controlled trials have yielded conflicting results regarding the ability of beta-blockers to influence perioperative cardiovascular morbidity and mortality. Thus routine prescription of these drugs in unselected patients remains a controversial issue. OBJECTIVES: The objective of this review was to systematically analyse the effects of perioperatively administered beta-blockers for prevention of surgery-related mortality and morbidity in patients undergoing any type of surgery while under general anaesthesia...
March 13, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29529205/carotid-stenosis-with-impaired-brain-flow-reserve-is-associated-with-an-increased-risk-of-stroke-in-on-pump-cardiovascular-surgery
#16
Kazumasa Tsuda, Norihiko Shiiya, Naoki Washiyama, Katsushi Yamashita, Kazuhiro Ohkura, Daisuke Takahashi, Yumi Kando, Kayoko Natsume, Ken Yamanaka, Yuki Takeuchi
OBJECTIVES: To prevent haemodynamic stroke during cardiovascular surgery in patients with carotid stenosis, we routinely evaluated magnetic resonance angiography and selectively evaluated brain perfusion single-photon emission computed tomography with acetazolamide challenge. Off-pump surgery was preferred when cerebral blood flow reserve was impaired. This strategy's usefulness was investigated. METHODS: Among the 1059 consecutive patients who underwent preoperative carotid screening by magnetic resonance angiography, 84 (7...
February 26, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29525764/hospital-readmission-after-perioperative-acute-myocardial-infarction-associated-with-noncardiac-surgery
#17
Nathaniel R Smilowitz, Joshua A Beckman, Scott E Sherman, Jeffrey S Berger
BACKGROUND : Acute myocardial infarction (AMI) is a major cardiovascular complication of noncardiac surgery. We aimed to evaluate the frequency, causes, and outcomes of 30-day hospital readmission after perioperative AMI. METHODS : Patients who were diagnosed with AMI during hospitalization for major noncardiac surgery were identified using the 2014 US Nationwide Readmission Database. Rates, causes, and costs of 30-day readmissions after noncardiac surgery with and without perioperative AMI were identified...
March 10, 2018: Circulation
https://www.readbyqxmd.com/read/29514697/cardiac-output-optimisation-following-liver-transplant-colt-trial-study-protocol-for-a-feasibility-randomised-controlled-trial
#18
Farid Froghi, Rahul Koti, Kurinchi Gurusamy, Susan Mallett, Douglas Thorburn, Linda Selves, Sarah James, Jeshika Singh, Manuel Pinto, Christine Eastgate, Margaret McNeil, Helder Filipe, Fatima Jichi, Nick Schofield, Daniel Martin, Brian Davidson
BACKGROUND: Patients with liver cirrhosis undergoing liver transplantation have a hyperdynamic circulation which persists into the early postoperative period making accurate assessment of fluid requirements challenging. Goal-directed fluid therapy (GDFT) has been shown to reduce morbidity and mortality in a number of surgery settings. The impact of GDFT in patients undergoing liver transplantation is unknown. A feasibility trial was designed to determine patient and clinician support for recruitment into a randomised controlled trial of GDFT following liver transplantation, adherence to a GDFT protocol, participant withdrawal, and to determine appropriate endpoints for a subsequent larger trial to evaluate the efficacy of GDFT in patients undergoing liver transplantation...
March 7, 2018: Trials
https://www.readbyqxmd.com/read/29514145/preoperative-midrregional-proadrenomedulin-and-high-sensitivity-troponin-t-predict-perioperative-cardiovascular-events-in-non-cardiac-surgery
#19
Mladjan Golubovic, Radmilo Jankovic, Dusan Sokolovic, Vladan Cosic, Vesna Maravic, Tomislav Kostic, Zoran Perisic, Nebojsa Ladjevic
OBJECTIVE: We evaluated the utility of preoperative mid-regional pro-adrenomedulin (MR-proADM) and cardiac troponin T (TnT) for improved detection of patients at high risk for perioperative cardiac events and mortality after major non-cardiac surgery. SUBJECTS AND METHODS: This prospective, single-center, observational study enrolled 79 patients undergoing major non-cardiac surgery. After initial clinical assessment (clinical history, physical examination, echocardiogram, blood tests, and chest X-ray), mid-regional pro-adrenomedulin and high sensitivity troponin T (hsTnT) were measured within 48 hours prior to surgery by immunoluminometric and electrochemiluminescence-immuno assay...
March 7, 2018: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
https://www.readbyqxmd.com/read/29465201/-pulse-wave-transit-time-one-more-attempt-of-non-invasive-cardiac-output-measurement
#20
RANDOMIZED CONTROLLED TRIAL
B A Akselrod, L A Tolstova, T A Pshenichniy, S V Fedulova
BACKGROUND: Estimated continuous cardiac output (esCCOTM) based on pulse wave transit time is one of alternative non-invasive CO measurement techniques. METHODS: Randomized study included 23 scheduled patients operated upon due to cardiovascular diseases. Cardiac index (CI) was measured Comparative analyses of esCCO and others CO measurement methods used intraoperative was carried out. In the first group (n = 9) esCCO was compared with transpulmonary thermodilution (PiCCO-plus); in the second group (n = 8) - with pulmonary artery thermodilution; in the third group (n = 6) - with transoesophageal echocardiography (velocity-time integral)...
September 2017: Anesteziologiia i Reanimatologiia
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