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Diabetes and cardiac surgery

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https://www.readbyqxmd.com/read/29343294/effect-of-glycaemic-control-on-complications-following-cardiac-surgery-literature-review
#1
REVIEW
M Navaratnarajah, R Rea, R Evans, F Gibson, C Antoniades, A Keiralla, M Demosthenous, G Kassimis, G Krasopoulos
INTRODUCTION: No uniform consensus in the UK or Europe exists, for glycaemic management of patients with Diabetes or pre-diabetes undergoing cardiac surgery. OBJECTIVE: [i] Determine the relationship between glycaemic control and cardiac surgical outcomes; [ii] Compare current vs gold standard management of patients with Diabetes or pre-diabetes undergoing cardiac surgery. METHODS: Searches of MEDLINE, NHS Evidence and Web of Science databases were completed...
January 17, 2018: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29332196/bioelectronic-modulation-of-carotid-sinus-nerve-activity-in-the-rat-a-potential-therapeutic-approach-for-type-2-diabetes
#2
Joana F Sacramento, Daniel J Chew, Bernardete F Melo, Matteo Donegá, Wesley Dopson, Maria P Guarino, Alison Robinson, Jesus Prieto-Lloret, Sonal Patel, Bradley J Holinski, Nishan Ramnarain, Victor Pikov, Kristoffer Famm, Silvia V Conde
AIMS/HYPOTHESIS: A new class of treatments termed bioelectronic medicines are now emerging that aim to target individual nerve fibres or specific brain circuits in pathological conditions to repair lost function and reinstate a healthy balance. Carotid sinus nerve (CSN) denervation has been shown to improve glucose homeostasis in insulin-resistant and glucose-intolerant rats; however, these positive effects from surgery appear to diminish over time and are heavily caveated by the severe adverse effects associated with permanent loss of chemosensory function...
January 14, 2018: Diabetologia
https://www.readbyqxmd.com/read/29321796/heart-rate-variability-a-new-tool-to-predict-complications-in-adult-cardiac-surgery
#3
Antonio Nenna, Mario Lusini, Cristiano Spadaccio, Francesco Nappi, Salvatore Matteo Greco, Raffaele Barbato, Elvio Covino, Massimo Chello
Heart rate variability (HRV) refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV has been shown to be effective as a predictor of risk after myocardial infarction and an early warning sign of diabetic neuropathy, and in the cardiology setting is now recognized to be a useful tool for risk-stratification after hospital admission and after discharge. Recent evidences suggest that HRV analysis might predict complications even in patients undergoing cardiac surgery, and the present review summarizes the importance of HRV analysis in adult cardiac surgery and the perspectives for HRV use in current clinical practice...
November 2017: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/29317808/clinical-utility-of-the-revised-cardiac-risk-index-in-older-chinese-patients-with-known-coronary-artery-disease
#4
Lu Che, Li Xu, Yuguang Huang, Chunhua Yu
Objectives: The revised Cardiac Risk Index (RCRI) is the most widely used risk prediction tool for postoperative cardiac adverse events. We aim to explore the predictive ability of the RCRI in older Chinese patients with coronary artery disease (CAD) undergoing noncardiac surgery, which has not been previously evaluated. Methods: We performed a multicenter, prospective study. We enrolled a total of 1,202 patients, aged >60 years, with a history of CAD who underwent noncardiac surgery...
2018: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29314257/contemporary-management-and-outcomes-of-acute-type-a-aortic-dissection-an-analysis-of-the-sts-adult-cardiac-surgery-database
#5
Teng C Lee, Zachary Kon, Faisal H Cheema, Maria V Grau-Sepulveda, Brian Englum, Sunghee Kim, Paramita S Chaudhuri, Vinod H Thourani, Gorav Ailawadi, G Chad Hughes, Matthew L Williams, J Matthew Brennan, Lars Svensson, James S Gammie
PURPOSE: Management of acute type A aortic dissection (AAAD) is challenging and operative strategies are varied. We used the STS Adult Cardiac Surgery Database (STS ACSD) to describe contemporary surgical strategies and outcomes for AAAD. METHODS: Between July 2011 and September 2012, 2982 patients with AAAD underwent operations at 640 centers in North America. RESULTS: In this cohort, median age was 60 years old, 66% were male, and 80% had hypertension...
January 4, 2018: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29305679/decreased-coronary-arteriolar-response-to-kca-channel-opener-after-cardioplegic-arrest-in-diabetic-patients
#6
Yuhong Liu, Victoria Cole, Isabella Lawandy, Afshin Ehsan, Frank W Sellke, Jun Feng
We have recently found that diabetes is associated with the inactivation of the calcium-activated potassium channels (KCa) in endothelial cells, which may contribute to endothelial dysfunction in diabetic patients at baseline. In the current study, we further investigated the effects of diabetes on coronary arteriolar responses to the small (SK) and intermediate (IK) KCa opener NS309 in diabetic and non-diabetic patients and correlated that data with the changes in the SK/IK protein expression/distribution in the setting of cardioplegic ischemia and reperfusion (CP) and cardiopulmonary bypass (CPB)...
January 5, 2018: Molecular and Cellular Biochemistry
https://www.readbyqxmd.com/read/29305561/trends-in-cardiovascular-risk-factor-and-disease-prevalence-in-patients-undergoing-non-cardiac-surgery
#7
Nathaniel R Smilowitz, Navdeep Gupta, Yu Guo, Joshua A Beckman, Sripal Bangalore, Jeffrey S Berger
OBJECTIVES: Cardiovascular risk factors are prevalent in the population undergoing non-cardiac surgery. Changes in perioperative cardiovascular risk factor profiles over time are unknown. The objective of this study was to evaluate national trends in cardiovascular risk factors and atherosclerotic cardiovascular disease (ASCVD) among patients undergoing non-cardiac surgery. METHODS: Adults aged ≥45 years old who underwent non-cardiac surgery were identified using the US National Inpatient Sample from 2004 to 2013...
January 5, 2018: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29296066/multimodality-imaging-assessment-of-a-caseous-calcification-of-the-mitral-valve-annulus
#8
Imen Hamdi, Chadia Chourabi, Younes Arous, Mehdi Ghommidh, Khalil Houissa, Abdeddayem Haggui, Nadhem Hajlaoui, Dhaker Lahidheb, Nejmeddine Ben Abdallah, Wafa Fehri, Habib Haouala
Caseous calcification of the mitral annulus (CCMA) is a rare echocardiographic finding. It is commonly misdiagnosed as an abscess, tumor or infective vegetation on the mitral valve. Since it is a benign process, differentiating it from malignant intra-cardiac mass is primordial to avoid unnecessary surgery. Various imaging modalities can be complimentary for definitive diagnosis. We present a case of CCMA in a 71-year-old female patient. Her medical history revealed hypertension, diabetes mellitus, hyperlipidaemia and coronary artery disease...
January 2018: Journal of the Saudi Heart Association
https://www.readbyqxmd.com/read/29284341/cerebral-perfusion-monitoring-in-adult-patients-following-cardiac-surgery-an-observational-study
#9
Tammy Slater, Julie Stanik-Hutt, Patricia Davidson
BACKGROUND: Strokes following adult cardiac surgery contribute to burdensome neurocognitive complications, which are often difficult to detect during the perioperative period. Fluctuations in regional cerebral perfusion and co-morbid conditions, such as hypertension, diabetes, prior stroke, symptomatic carotid stenosis, aortic atherosclerotic disease, and peripheral vascular disease are associated with perioperative strokes. Approaches to achieve optimal cerebral perfusion remain elusive and traditional strategies for perioperative monitoring are not always sufficiently sensitive to detect acute changes in cerebral perfusion...
December 28, 2017: Contemporary Nurse
https://www.readbyqxmd.com/read/29282506/the-use-of-a-pre-operative-carbohydrate-drink-in-patients-with-diabetes-mellitus-a-prospective-non-inferiority-cohort-study
#10
Michael R Laffin, Shuai Li, Rondald Brisebois, Peter A Senior, Haili Wang
BACKGROUND: Pre-operative fasting leads to insulin resistance and increased metabolic stress in non-diabetic patients. Consumption of a carbohydrate drink may alleviate these deleterious effects. Patients with diabetes mellitus represent over 15% of the surgical population, yet concerns over hyperglycemia and aspiration have excluded patients with diabetes mellitus from studies assessing the utility of pre-operative carbohydrate drinks. OBJECTIVE: To assess for a clinically significant increase in pre-operative blood glucose concentration (defined as >2 mmol/L) in patients with diabetes consuming a pre-operative carbohydrate drink...
December 27, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29279000/oxygen-uptake-on-kinetics-during-six-minute-walk-test-predicts-short-term-outcomes-after-off-pump-coronary-artery-bypass-surgery
#11
Isadora Salvador Rocco, Marcela Viceconte, Hayanne Osiro Pauletti, Bruna Caroline Matos-Garcia, Natasha Oliveira Marcondi, Caroline Bublitz, Douglas William Bolzan, Rita Simone Lopes Moreira, Michel Silva Reis, Nelson Américo Hossne, Walter José Gomes, Ross Arena, Solange Guizilini
PURPOSE: We aimed to investigate the ability of oxygen uptake kinetics to predict short-term outcomes after off-pump coronary artery bypass grafting. METHODS: Fifty-two patients aged 60.9 ± 7.8 years waiting for off-pump coronary artery bypass surgery were evaluated. The 6-min walk test distance was performed pre-operatively, while simultaneously using a portable cardiopulmonary testing device. The transition of oxygen uptake kinetics from rest to exercise was recorded to calculate oxygen uptake kinetics fitting a monoexponential regression model...
December 26, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/29241990/influence-of-metformin-and-insulin-on-myocardial-substrate-oxidation-under-conditions-encountered-during-cardiac-surgery
#12
Cyonna Holmes, LaShondra Powell, Nicholas S Clarke, Michael E Jessen, Matthias Peltz
BACKGROUND: The influence of diabetic therapies on myocardial substrate selection during cardiac surgery is unknown but may be important to ensure optimal surgical outcomes. We hypothesized that metformin and insulin alter myocardial substrate selection during cardiac surgery and may affect reperfusion cardiac function. METHODS: Rat hearts (n = 8 per group) were evaluated under 3 metabolic conditions: normokalemia, cardioplegia, or bypass. Groups were perfused with Krebs-Henseleit buffer in the presence of no additives, metformin, insulin, or both insulin and metformin...
December 11, 2017: Surgery
https://www.readbyqxmd.com/read/29241487/surgical-versus-percutaneous-coronary-revascularization-in-patients-with-diabetes-and-acute%C3%A2-coronary-syndromes
#13
RANDOMIZED CONTROLLED TRIAL
Krishnan Ramanathan, James G Abel, Julie E Park, Anthony Fung, Verghese Mathew, Carolyn M Taylor, G B John Mancini, Min Gao, Lillian Ding, Subodh Verma, Karin H Humphries, Michael E Farkouh
BACKGROUND: Randomized trial data support the superiority of coronary artery bypass grafting (CABG) surgery over percutaneous coronary intervention (PCI) in diabetic patients with multivessel coronary artery disease (MV-CAD). However, whether this benefit is seen in a real-world population among subjects with stable ischemic heart disease (SIHD) and acute coronary syndromes (ACS) is unknown. OBJECTIVES: The main objective of this study was to assess the generalizability of the FREEDOM (Future REvascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multi-vessel Disease) trial in real-world practice among patients with diabetes mellitus and MV-CAD in residents of British Columbia, Canada...
December 19, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29233098/intractable-ascites-associated-with-mycophenolate-in-a-simultaneous-kidney-pancreas-transplant-patient-a-case-report
#14
Nina T Weber, Ali Sigaroudi, Alexander Ritter, Andreas Boss, Kuno Lehmann, David Goodman, Stefan Farese, Stefan Weiler, Thomas F Mueller
BACKGROUND: Mycophenolic acid (MPA), either given as an ester pro-drug or as an enteric-coated sodium salt, is the most commonly prescribed anti-proliferative immunosuppressive agent used following organ transplantation and widely applied in immune-mediated diseases. Clinicians are well aware of common adverse reactions related to MPA treatment, in particular diarrhea, leukopenia and infections. Here we report a case of severe, persistent ascites associated with MPA treatment. The otherwise unexplained and intractable ascites, requiring repeated paracenteses for more than 8 months, rapidly ceased with stopping the MPA treatment...
December 12, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/29232296/morbid-obesity-does-not-increase-morbidity-or-mortality-in-robotic-cardiac-surgery
#15
Hiroto Kitahara, Brooke Patel, Mackenzie McCrorey, Sarah Nisivaco, Husam H Balkhy
OBJECTIVE: Morbid obesity (body mass index ≥ 35 kg/m) usually confers a higher perioperative risk in cardiac surgery. Robotic cardiac surgery may have many advantages for these high-risk patients. METHODS: We retrospectively reviewed patients undergoing robotic cardiac surgery from July 2013 to April 2017 at our institution. We compared the outcomes of morbidly obese patients versus nonobese patients. RESULTS: A total of 486 patients underwent robotic cardiac surgery (322 men, median age = 65 years)...
November 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/29231752/differences-between-slovak-and-dutch-patients-scheduled-for-coronary-artery-bypass-graft-surgery-regarding-clinical-and-psychosocial-predictors-of-physical-and-mental-health-related-quality-of-life
#16
Noha El-Baz, Daniela Ondusova, Martin Studencan, Jaroslav Rosenberger, Sijmen A Reijneveld, Jitse P van Dijk, Berrie Middel
BACKGROUND: Differences in health-related quality of life in coronary artery disease patients and associated factors between patients of central and western European descent are rarely investigated. We aim to test differences between Dutch and Slovak health-related quality of life, whether nationality predicted health-related quality of life and if standardised beta weights of health-related quality of life determinants differ across countries. DESIGN: An observational multicentre study at university cardiac centres in the Netherlands and Slovakia...
December 1, 2017: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29230803/peri-operative-management-of-patients-with-type-2-diabetes-mellitus-undergoing-non-cardiac-surgery-using-liraglutide-glucose-insulin-potassium-infusion-or-intravenous-insulin-bolus-regimens-a-randomised-controlled-trial
#17
J A W Polderman, S C J van Steen, B Thiel, M B Godfried, P L Houweling, M W Hollmann, J H DeVries, B Preckel, J Hermanides
In this open-label multicentre randomised controlled trial, we investigated three peri-operative treatment strategies to lower glucose and reduce the need for rescue insulin in patients aged 18-75 years with type-2 diabetes mellitus undergoing non-cardiac surgery. Patients were randomly allocated using a web-based randomisation program to premedication with liraglutide (liraglutide group), glucose-insulin-potassium infusion (insulin infusion group) or insulin bolus regimen (insulin bolus group), targeting a glucose < 8...
December 12, 2017: Anaesthesia
https://www.readbyqxmd.com/read/29230421/association-of-vitamin-d-deficiency-and-degree-of-coronary-artery-disease-in-cardiac-patients-with-type-2-diabetes
#18
Ewelina A Dziedzic, Jakub S Gąsior, Mariusz Pawłowski, Marek Dąbrowski
Several modifiable factors may influence cardiac function in diabetic patients. The aim of the study was to evaluate the influence of vitamin D level on the stage of coronary atherosclerosis in cardiac patients diagnosed with type 2 diabetes. The study was performed in 337 consecutive patients undergoing coronarography. The stage of atherosclerosis was evaluated using Coronary Artery Surgery Study Score. The plasma 25(OH)D concentration was determined by an electrochemiluminescence method. Patients without significant lesions in coronary arteries presented the highest 25(OH)D level, significantly higher than patients with one-, two-, and three-vessel coronary artery disease (CAD) (p < 0...
2017: Journal of Diabetes Research
https://www.readbyqxmd.com/read/29223421/a-prospective-multi-institutional-cohort-study-of-mediastinal-infections-after-cardiac-operations
#19
Louis P Perrault, Katherine A Kirkwood, Helena L Chang, John C Mullen, Brian C Gulack, Michael Argenziano, Annetine C Gelijns, Ravi K Ghanta, Bryan A Whitson, Deborah L Williams, Nancy M Sledz-Joyce, Brian Lima, Giampaolo Greco, Nishit Fumakia, Eric A Rose, John D Puskas, Eugene H Blackstone, Richard D Weisel, Michael E Bowdish
BACKGROUND: Mediastinal infections are a potentially devastating complication of cardiac operations. This study analyzed the frequency, risk factors, and perioperative outcomes of mediastinal infections after cardiac operations. METHODS: In 2010, 5,158 patients enrolled in a prospective study evaluating infections after cardiac operations and their effect on readmissions and mortality for up to 65 days after the procedure. Clinical and demographic characteristics, operative variables, management practices, and outcomes were compared for patients with and without mediastinal infections, defined as deep sternal wound infection, myocarditis, pericarditis, or mediastinitis...
December 6, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29218804/impact-of-diabetes-on-free-flap-surgery-of-the-head-and-neck-a-nsqip-analysis
#20
Jacob S Brady, Aparna Govindan, Meghan M Crippen, Andrey Filimonov, Jean Anderson Eloy, Soly Baredes, Richard Chan Woo Park
OBJECTIVE: Diabetes is associated with microvascular pathology and may predispose patients undergoing microvascular surgery to complications. This study assesses diabetes as a risk factor for complications following free flap surgery of the head and neck. PATIENTS AND METHODS: In this retrospective cohort study, data on free flap surgeries of the head and neck between 2005 and 2014 was collected from the National Surgical Quality Improvement Program (NSQIP) database...
December 8, 2017: Microsurgery
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