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Noncardiac Surgery (noncardiac + surgery)
Selected AbstractsPerioperative Outcome and Long-Term Mortality for Heart Failure Patients Undergoing Intermediate- and High-Risk Noncardiac Surgery: Impact of Left Ventricular Ejection FractionCONGESTIVE HEART FAILURE, Issue 2 2010Kirsten O. Healy MD The impact of left ventricular ejection fraction (LVEF) on outcome in patients with heart failure (HF) undergoing noncardiac surgery has not been extensively evaluated. In this study, 174 patients (mean age, 75±12 years, 47% male, mean LVEF (47%±18%) underwent intermediate- or high-risk noncardiac surgery. Patients were stratified by LVEF, and adverse perioperative complications were identified and compared. Adverse perioperative events occurred in 53 patients (30.5%), including 14 (8.1%) deaths within 30 days, 26 (14.9%) myocardial infarctions, and 44 (25.3%) HF exacerbations. Among the factors associated with adverse perioperative outcomes in the first 30 days were advanced age (>80 years), diabetes, and a severely decreased LVEF (<30%). Long-term mortality was high, and Cox proportional hazards analysis demonstrated that LVEF was an independent risk factor for long-term mortality. Congest Heart Fail. 2010;16:45,49. © 2009 Wiley Periodicals, Inc. [source] Diagnostic and Prognostic Use of Stress Echocardiography in Stable PatientsECHOCARDIOGRAPHY, Issue 5 2000Steven C. Smart M.D. Stress echocardiography is an effective diagnostic and prognostic technique in stable patients with known or suspected coronary artery disease (CAD), myocardial infarction, or chronic left ventricular dysfunction and those undergoing noncardiac surgery. Stress echocardiography is sensitive and specific for the detection and extent of CAD. Negative tests confer a high negative predictive value for cardiac events regardless of the clinical risk. Positive studies confer a high positive predictive value for ischemic events in patients with intermediate to high clinical risk. Stress echocardiography provides incremental prognostic information relative to clinical, resting echocardiographic, and angiographic data. Meta-analysis studies have shown that the diagnostic and prognostic information provided by stress echocardiography is comparable to that from radionuclide scintigraphic stress tests. Stress echocardiography may be more specific for the detection and extent of CAD, whereas radionuclide scintigraphy may be more sensitive for one-vessel disease. Sensitivities are similar for the detection and extent of disease in patients with multivessel CAD. [source] Impact of chronic advanced aortic regurgitation on the perioperative outcome of noncardiac surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010H.-C. LAI Background: Whether and how chronic advanced aortic regurgitation (AR) impacts the perioperative outcome of noncardiac surgery remains unclear. Methods: From November 1999 to December 2006, all patients undergoing noncardiac operations and ever examined by echocardiography within the last 6 months were screened. Those with chronic moderate,severe or severe AR were enrolled, provided they were not already trachea-intubated or aortic valve operated, and the surgery was not performed under local anesthesia. Case-matched subjects without significant AR served as controls. The perioperative outcomes of these patients were analyzed, and independent prognostic correlates were investigated by multivariate logistic regression analysis. Results: A total of 167 patients (male 131, mean age of 75 years) complying with the enrollment criteria were studied. Compared with the other 167 case-matched control peers, patients with advanced AR risked potential hazards of serious hemodynamic instability (0.6%) and circulatory collapse (1.2%) during surgery despite the similar incidence of overall cardiac adverse events, and were further distressed with more cardiopulmonary complications (16.2% vs. 5.4%, P=0.003) and in-hospital deaths (9% vs. 1.8%, P=0.008) post-operatively. Multivariate regression analysis confirmed the correlation of advanced AR with perioperative mortality, and identified depressed left ventricular function, renal dysfunction, high surgical risk, and lack of cardiac medication as predictors of in-hospital death. Conclusion: Chronic advanced AR complicates the perioperative outcome of noncardiac surgery as reflected by frequent cardiopulmonary morbidities and in-hospital deaths, especially when coexisting with specified high-risk clinical and surgical characteristics. [source] Preoperative cardiac risk stratification 2007: Evolving evidence, evolving strategiesJOURNAL OF HOSPITAL MEDICINE, Issue 3 2007FACP, Steven L. Cohn MD Abstract Various guidelines and risk indices have optimized cardiac risk stratification, and the emphasis has shifted to reducing perioperative risk. This review is an update on invasive (CABG/PCI) and noninvasive (medical therapy with beta-blockers, alpha-agonists, and statins) strategies to reduce cardiac risk for noncardiac surgery and the controversies surrounding their use. Journal of Hospital Medicine 2007;2:174,180. © 2007 Society of Hospital Medicine. [source] Perioperative myocardial infarction in noncardiac surgery: the diagnostic and prognostic role of cardiac troponinsJOURNAL OF INTERNAL MEDICINE, Issue 1 2002S. LUCREZIOTTI Abstract.,Lucreziotti S, Foroni C, Fiorentini C (Universitą degli Studi di Milano, Ospedale S. Pado, Milano, Italy). Perioperative myocardial infarction in noncardiac surgery: the diagnostic and prognostic role of cardiac troponins (Review). J Intern Med 2002; 252: 11,20. Despite the number of technologies used, the diagnosis of perioperative myocardial infarction is still a challenge. Studies conducted in surgical series have demonstrated that cardiac troponins (cTns) have both a superior diagnostic sensitivity and specificity, compared with other traditional techniques, and an independent power to predict short- and long-term prognosis. Nevertheless, some points need to be clarified. They include the usefulness of cTns in patients with end-stage renal failure; the standardization of the cTns cut-off for the diagnosis of myocardial injury; the timing of postoperative blood samplings; the cost-effectiveness of a screening in asymptomatic patients; and the possible therapeutic strategies. [source] Serum concentration of S-100 protein in assessment of cognitive dysfunction after general anesthesia in different types of surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2002U. Linstedt Background: S-100 protein serum concentration (S-100) serves as a marker of cerebral ischemia in cardiac surgery, head injury and stroke. In these circumstances S-100 corresponds well with the results of neuropsychological tests. The aim of the present study was to investigate the value of S-100 and neuron specific enolase (NSE) in reflecting postoperative cognitive deficit (POCD) after general surgical procedures. Methods: One hundred and twenty patients undergoing vascular, trauma, urological or abdominal surgery were investigated. Serum values of S-100 and NSE were determined preoperatively and 0.5, 4, 18 and 36 h postoperatively. Neuropsychological tests for detecting POCD were performed preoperatively and on day 1, 3, and 6 after the operation. A decline of more than 10% in neuropsychological test results was regarded as POCD. Furthermore, we retrospectively compared the S-100 in patients with and without POCD in different types of surgery. Results: According to our definition, forty -eight patients had POCD (95% confidence interval: 37.5,58.5). These patients showed higher serum concentrations of S-100 (median 024 ng/ml; range 0.01,3.3 ng/ml) compared with those without POCD (n=69; median 0.14 ng/ml; range 0,1.34 ng/ml) 30 min postoperatively (P=0.01). Neuron specific enolase was unchanged during the course of the study. Differences of S-100 in patients with and without POCD were found in abdominal and vascular surgery but not in urological surgery. Conclusion: When all patients are pooled, S-100 appears to be suitable in the assessment of incidence, course and outcome of cognitive deficits. We suspect that in some surgical procedures, such as urological surgery, S-100 appears to be of limited value in detecting POCD. Neuron specific enolase did not reflect neuropsychological dysfunction after noncardiac surgery. [source] A meta-analysis of the prospective randomised trials of coronary revascularisation before noncardiac vascular surgery with attention to the type of coronary revascularisation performedANAESTHESIA, Issue 10 2009B. M. Biccard Summary Prospective randomised trials of coronary revascularisation prior to noncardiac surgery have shown no survival benefit following noncardiac surgery. However, these studies have not differentiated the outcomes associated with coronary artery bypass grafting (CABG) and percutaneous coronary interventions. We performed a meta-analysis of the randomised controlled trials of pre-operative coronary revascularisation for noncardiac surgery, extracting data for 30 day and long term all-cause mortality and myocardial infarction (MI) following revascularisation, according to the type of revascularisation performed. Pre-operative percutaneous coronary intervention was associated with significantly increased 30 day MI and composite death and MI. Pre-operative CABG was associated with a significantly improved long term composite outcome of death and MI compared to percutaneous coronary interventions. The adverse effect of percutaneous coronary interventions on both short and long term outcomes in vascular surgical patients should be taken into consideration when interpreting these trials. CABG may improve long term outcomes in vascular surgical patients. The indications for and timing of CABG in vascular surgical patients needs further research. [source] Late thrombosis of sirolimus-eluting stents following noncardiac surgeryCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2005Mithal Nasser MD Abstract We describe two patients with in-stent thrombosis occurring 4 and 21 months after implantation of sirolimus-eluting stents. Both cases occurred following noncardiac surgery. In both cases, aspirin had been stopped prior to surgery. Both patient sustained a severe myocardial infarction; one died. The occurrence of late thrombosis of sirolimus-eluting stents is of concern. © 2005 Wiley-Liss, Inc. [source] Major noncardiac surgery following coronary stenting: When is it safe to operate?CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2004Arvind K. Sharma MD Abstract The optimal timing for elective noncardiac surgery (NCS) after coronary stenting is uncertain. We identified 47 patients who underwent elective NCS within 90 days of coronary stent placement between January 1995 and December 2000. Twenty-seven patients had NCS within 3 weeks of coronary stenting. Six of the seven in whom thienopyridine antiplatelet therapy was discontinued died postoperatively in a manner suggestive of stent thrombosis. In contrast, only 1 of the 20 patients in whom the thienopyridine was continued through the NCS died. The frequency of perioperative hemorrhage was similar whether or not the antiplatelet agent was continued. Only 1 perioperative death occurred in the 20 patients with NCS more than 3 weeks following stenting. Catheter Cardiovasc Interv 2004;63:141,145. © 2004 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||