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Cardiovascular perioperative evaluation

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https://www.readbyqxmd.com/read/29025297/liver-transplantation-in-patients-with-cardiac-disease
#1
Christopher L Wray
Liver transplantation (LT) is a unique surgical procedure that has major hemodynamic and cardiovascular implications. Recently, there has been significant interest focused on cardiovascular issues that affect LT patients in all phases of the perioperative period. The preoperative cardiac evaluation is a major step in the selection of LT candidates. LT candidates are aging in concordance with the general population; cardiovascular disease and their risk factors are highly associated with older age. Underlying cardiovascular disease has the potential to affect outcomes in LT patients and has a major impact on candidate selection...
October 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28985025/multidisciplinary-approach-to-cardiac-and-pulmonary-vascular-disease-risk-assessment-in-liver-transplantation-an-evaluation-of-the-evidence-and-consensus-recommendations
#2
Lisa B VanWagner, Matthew E Harinstein, James R Runo, Christopher Darling, Marina Serper, Shelley Hall, Jon A Kobashigawa, Laura L Hammel
Liver transplant (LT) candidates today are older, have greater medical severity of illness, and have more cardiovascular comorbidities than ever before. In addition, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Cirrhotic cardiomyopathy, a condition characterized by increased cardiac output and a reduced ventricular response to stress, is present in up to 30% of patients with cirrhosis thus challenging perioperative management. Current noninvasive tests that assess for subclinical coronary and myocardial disease have low sensitivity, and altered hemodynamics during the LT surgery can unmask latent cardiovascular disease either intraoperatively or in the immediate postoperative period...
October 6, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28976400/-perioperative-assessment-of-elderly-patient-with-cardiovascular-disease
#3
Evrim Şimşek, Cahide Soydaş Çınar
Elderly people who require surgery is increasing as a resul of increased life expectancy. Surgery is a major stress factor for all patients however older patients have limited reserve to handle this stress. In this review preoperative assessment of cardiovascular reserve in elderly population and major subjects to take attention in perioperative period were evaluated according to recent guidelines and literatüre.
September 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28974076/association-between-preoperative-pulse-pressure-and-perioperative-myocardial-injury-an-international-observational-cohort-study-of-patients-undergoing-non-cardiac-surgery
#4
T E F Abbott, R M Pearse, R A Archbold, A Wragg, E Kam, T Ahmad, A W Khan, E Niebrzegowska, R N Rodseth, P J Devereaux, G L Ackland
Background: The management of elevated blood pressure before non-cardiac surgery remains controversial. Pulse pressure is a stronger predictor of cardiovascular morbidity in the general population than systolic blood pressure alone. We hypothesized that preoperative pulse pressure was associated with perioperative myocardial injury. Methods: This is a secondary analysis of the Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation (VISION) international cohort study...
July 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28973220/effect-of-individualized-vs-standard-blood-pressure-management-strategies-on-postoperative-organ-dysfunction-among-high-risk-patients-undergoing-major-surgery-a-randomized-clinical-trial
#5
RANDOMIZED CONTROLLED TRIAL
Emmanuel Futier, Jean-Yves Lefrant, Pierre-Gregoire Guinot, Thomas Godet, Emmanuel Lorne, Philippe Cuvillon, Sebastien Bertran, Marc Leone, Bruno Pastene, Vincent Piriou, Serge Molliex, Jacques Albanese, Jean-Michel Julia, Benoit Tavernier, Etienne Imhoff, Jean-Etienne Bazin, Jean-Michel Constantin, Bruno Pereira, Samir Jaber
Importance: Perioperative hypotension is associated with an increase in postoperative morbidity and mortality, but the appropriate management strategy remains uncertain. Objective: To evaluate whether an individualized blood pressure management strategy tailored to individual patient physiology could reduce postoperative organ dysfunction. Design, Setting, and Participants: The Intraoperative Norepinephrine to Control Arterial Pressure (INPRESS) study was a multicenter, randomized, parallel-group clinical trial conducted in 9 French university and nonuniversity hospitals...
October 10, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28967731/new-assessment-for-advanced-age-italian-study-protocol-on-the-assessment-of-surgical-risk-in-the-over-75-year-age-group
#6
Annarita Pilleri, Giampaolo Scorcu
The role of age in the risk stratification of patients candidate for non-cardiac surgery is still today an unresolved issue. European guidelines, in contrast to American guidelines, do not attribute to age an independent role in increasing the risk, and the indices for assessment of perioperative cardiovascular risk are based on studies that were carried out on middle-aged subgroups of the population without specific attention to the elderly patient. While the indices of geriatric assessment have still not yet gained a standardized role in the risk stratification of patients candidate to non-cardiac surgery, their need is becoming increasingly urgent considering the epidemiological impact of elderly patients with multi-comorbidities who more and more in the future will undergo such interventions...
July 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28967723/preoperative-cardiac-risks-in-noncardiac-surgery-the-role-of-coronary-angiography
#7
Carlo Lombardi, Marco Sbolli, Dario Cani, Garbriele Masini, Marco Metra, Pompilio Faggiano
The preoperative  evaluation of  patients candidates  to noncardiac  surgery requires a knowledge  of  factors  related  both to  type of  surgery and  to  features of the  single patient, potentially  responsible  for  perioperative  cardiovascular  complications , fatal and nonfatal. The assessment of   symptoms  and/or noninvasive  testing indicating the  presence of  coronary  artery  disease may  suggest the  need  for  medical therapy  optimization and, eventually, coronary  arteriography  before  the  scheduled timing  of noncardiac  surgery...
July 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28967722/cardiovascular-risk-assessment-in-the-senior-population-undergoing-anesthesia-for-non-cardiac-surgery
#8
Concezione Tommasino
Older patients are underrepresented in major cardiovascular trials, and only relatively healthy elderly patients, with few comorbidities or functional impairments, have been enrolled. As a result, current guidelines are unable to provide evidence-based recommendations for anesthesia treatment of patients aged ≥75 years, undergoing non-cardiac surgical procedures. Effective strategies, aimed at reducing the risk of perioperative cardiac complications, should involve cardiac evaluation using mostly medical history...
July 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28967721/prognostic-impact-of-frailty-in-elderly-cardiac-surgery-patients
#9
Francesco Vetta, Gabriella Locorotondo, Giampaolo Vetta, Maria Mignano, Sonia Bracchitta
Over the past few decades, the progressive aging of the population combined with the resulting increase in cardiovascular disease and the marked improvement of technologies applied to surgery justify the marked increase of the elderly patients requiring cardiovascular surgery. This claims a highly skilled perioperative management, which should be aimed at treating cardiac disease without increasing risk of hospitalization-related harmful events. Current preoperative assessment for cardiac surgery, such as the European System for Cardiac Operative Risk Evaluation II (EUROSCORE II) and the Society of Thoracic Surgeons (STS) risk score, are limited in their ability to predict perioperative outcomes in older patients...
July 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28967720/current-multivariate-risk-scores-in-patients-undergoing-non-cardiac-surgery
#10
Gian Francesco Mureddu
Several indexes to predict perioperative cardiovascular risk have been proposed overtime. The most widely used is the Revised Cardiac Risk Index (RCRI) developed by Lee since 1999. It predicts major cardiac outcomes from five independent clinical determinants: history of ischemic heart disease, history of cardiovascular disease, heart failure, insulin-dependent diabetes mellitus, and chronic renal failure (i.e. serum creatinine >2 mg/dl). In external validation studies, the RCRI showed high negative predictive value in all groups of age, indicating that it may be used to identify people at low risk for perioperative adverse cardiovascular events in noncardiac surgery...
July 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28967714/preoperative-risk-evaluation-in-patients-over-75-years-candidates-to-non-cardiac-and-cardiac-surgery
#11
Alessandro Boccanelli, Pompilio Faggiano
In the 24th and 25thof June 2016, 80 national experts were invited to Rome from The Italian Society of Geriatric Cardiology and the Italian Association of Cardiovascular Prevention and Rehabilitation to revise the current knowledge on the perioperative risk in the elderly. Cardiologists, geriatricians, heart and general surgeons and anesthesiologists discussed the topic with the objective of reaching a consensus and to launch observational research and registries in the field of perioperative risk evaluation in the elderly...
July 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28923700/venous-thromboembolism-risk-in-patients-with-locoregional-urothelial-tract-tumors
#12
Jorge D Ramos, Jonathan T Wingate, Roman Gulati, Elizabeth R Plimack, Lauren C Harshman, Thomas Powles, Simon J Crabb, Guenter Niegisch, Joaquim Bellmunt, Sylvain Ladoire, Ugo De Giorgi, Syed Hussain, Ajjai S Alva, Jack Baniel, Neeraj Agarwal, Jonathan E Rosenberg, Ulka N Vaishampayan, Matthew D Galsky, Evan Y Yu
BACKGROUND: Venous thromboembolism (VTE) is common in cancer patients, but there is limited data on patients with urothelial tract tumors (UTT). We previously identified several associative factors for increased VTE rates in patients with metastatic UTT. In this study, we assessed the frequency, associative factors, and impact on survival of VTE in patients with locoregional UTT. METHODS: Patients with locoregional bladder, upper urinary tract, or urethral cancer were included in this multi-center study from 29 academic institutions...
August 24, 2017: Clinical Genitourinary Cancer
https://www.readbyqxmd.com/read/28870052/-clinical-efficacy-of-enhanced-recovery-after-surgery-in-atrial-caval-shunting-for-type-%C3%A2-budd-chiari-syndrome
#13
G J Tian, D Y Li, H B Yu, Y D Dong, Y N Peng, P Liu, Y K Wei, H Z Xue
Objective: To investigate the clinical efficacy of enhanced recovery after surgery(ERAS) in atrial caval shunting (ACS) for type Ⅱ Budd-Chiari syndrome(BCS). Methods: The clinical data of patients underwent ACS for type Ⅱ BCS in the Henan Province People's Hospital from January 2014 to June 2016 were prospectively analyzed.Randomized and single-blind, controlled study was performed among the patients, and all of them underwent ACS and were divided into control group (patients underwent traditional perioperative management) and ERAS group (patients underwent ERAS perioperative management) based on a random number table...
September 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/28857800/outcomes-in-patients-undergoing-cardiac-surgery-who-decline-transfusion-and-received-erythropoietin-compared-to-patients-who-did-not-a-matched-cohort-study
#14
Lorent Duce, Mary L Cooter, Sharon L McCartney, Frederick W Lombard, Nicole R Guinn
BACKGROUND: Erythropoiesis-stimulating agents, such as erythropoietin (EPO), can be used to treat preoperative anemia. Some studies suggest an increased risk of mortality and thrombotic events, and use in cardiovascular surgery remains off-label. This study compares outcomes in cardiac surgery patients declining blood transfusion who received EPO with a matched cohort who did not. METHODS: After institutional review board approval, we conducted a retrospective review of all patients who decline blood transfusion who underwent cardiac surgery and received EPO between January 1, 2004, and June 15, 2015, at a single institution...
August 29, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28844467/patient-selection-and-perioperative-outcomes-of-bypass-and-endovascular-intervention-as-first-revascularization-strategy-for-infrainguinal-arterial-disease
#15
Thomas C F Bodewes, Jeremy D Darling, Sarah E Deery, Thomas F X O'Donnell, Alexander B Pothof, Katie E Shean, Frans L Moll, Marc L Schermerhorn
OBJECTIVE: The optimal initial revascularization strategy remains uncertain for patients with peripheral arterial disease. The purpose of this study was to evaluate current nationwide selection and perioperative outcomes of patients undergoing bypass or endovascular intervention for infrainguinal disease in those with no prior ipsilateral revascularization. METHODS: Patients undergoing nonemergent first-time infrainguinal revascularization were identified in the Targeted Vascular module of the National Surgical Quality Improvement Program (NSQIP) for 2011 to 2014 and stratified by symptom status (chronic limb-threatening ischemia [CLTI] or claudication)...
August 22, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28842832/perioperative-management-of-antithrombotic-therapy-in-patients-receiving-cardiovascular-implantable-electronic-devices-a-network-meta-analysis
#16
Hua He, Bing-Bing Ke, Yan Li, Fu-Sheng Han, Xiaodong Li, Yu-Jie Zeng
PURPOSE: Network meta-analysis (NMA) has advantages including being able to simultaneously compare and rank multiple treatments over traditional meta-analysis. We evaluated by a NMA the optimal antithrombotic strategy during the perioperative period of implantation of cardiovascular implantable electronic devices (CIEDs). METHODS: We performed a network meta-analysis of observational studies (cohort and case-control studies). The eligible studies tested the following antithrombotic therapy during the CIED placement: aspirin, clopidogrel, warfarin, novel oral anticoagulants (NOACs), and heparin bridging...
August 25, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28842773/reduction-of-framingham-bmi-score-after-rapid-weight-loss-in-severely-obese-subjects-undergoing-sleeve-gastrectomy-a-single-institution-experience
#17
David Gutierrez-Blanco, David Funes-Romero, SriGita Madiraju, Federico Perez-Quirante, Emanuele Lo Menzo, Samuel Szomstein, Raul J Rosenthal
BACKGROUND: There is vast evidence that supports the importance of obesity in the pathogenesis and progression of cardiovascular disease. Rapid weight loss induced by laparoscopic Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (LAGB) has proven beneficial. The aim of this study is to evaluate laparoscopic sleeve gastrectomy (LSG) as an alternative treatment modality and its impact on the Framingham-BMI 10-year risk score. METHODS: We retrospectively reviewed all patients that underwent bariatric surgery at our institution between 2010 and 2014...
August 25, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28830227/day-case-holmium-laser-enucleation-of-the-prostate-holep-prospective-evaluation-of-90-consecutive-cases
#18
Vincent Comat, Thibault Marquette, Willy Sutter, Gilles Pasticier, Gregoire Capon, Jean-Christophe Bernhard, Henri Bensadoun, Jean-Marie Ferriere, Gregoire Robert
PURPOSE: To prospectively assess the feasibility and safety of Holmium Laser Enucleation of the Prostate (HoLEP) as day-case surgery for the treatment of benign prostatic hyperplasia. MATERIALS AND METHODS: A prospective observational study was conducted by a single surgeon between June 2012 and October 2015. Except for patients ineligible for day-case surgery due to unstable cardiovascular disease, all patients with lower urinary tract symptoms presumably due to benign prostatic hyperplasia were consecutively included...
August 22, 2017: Journal of Endourology
https://www.readbyqxmd.com/read/28821166/perioperative-acute-myocardial-infarction-associated-with-non-cardiac-surgery
#19
Nathaniel R Smilowitz, Navdeep Gupta, Yu Guo, Jeffrey S Berger, Sripal Bangalore
Aims: Acute myocardial infarction (AMI) is a significant cardiovascular complication following non-cardiac surgery. We sought to evaluate national trends in perioperative AMI, its management, and outcomes. Methods and results: Patients who underwent non-cardiac surgery from 2005 to 2013 were identified using the United States National Inpatient Sample. Perioperative AMI was evaluated over time. Propensity score matching was used to compile a cohort of AMI patients managed invasively (defined as cardiac catheterization or coronary revascularization) vs...
August 14, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28820484/platelet-aggregometry-testing-molecular-mechanisms-techniques-and-clinical-implications
#20
REVIEW
Katalin Koltai, Gabor Kesmarky, Gergely Feher, Antal Tibold, Kalman Toth
Platelets play a fundamental role in normal hemostasis, while their inherited or acquired dysfunctions are involved in a variety of bleeding disorders or thrombotic events. Several laboratory methodologies or point-of-care testing methods are currently available for clinical and experimental settings. These methods describe different aspects of platelet function based on platelet aggregation, platelet adhesion, the viscoelastic properties during clot formation, the evaluation of thromboxane metabolism or certain flow cytometry techniques...
August 18, 2017: International Journal of Molecular Sciences
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