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Perioperative Myocardial Infarction (perioperative + myocardial_infarction)

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Medical Sciences	100%

Selected Abstracts

Perioperative myocardial infarction in noncardiac surgery: the diagnostic and prognostic role of cardiac troponins

JOURNAL OF INTERNAL MEDICINE, Issue 1 2002
S. LUCREZIOTTI
Abstract.,Lucreziotti S, Foroni C, Fiorentini C (Università 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]

Perioperative myocardial infarction after cesarean section in a young woman with hypertrophic obstructive cardiomyopathy

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2008
J. D. Schmitto
No abstract is available for this article. [source]

Results of Treatment Methods in Cardiac Arrest Following Coronary Artery Bypass Grafting

JOURNAL OF CARDIAC SURGERY, Issue 3 2009
Mehmet R. Guney M.D.
We evaluated the short- and long-term consequences of these two methods and discussed the indications for re-revascularization. Methods: Between 1998 and 2004, a total of 148 CABG patients, who were complicated with cardiac arrest, were treated with emergency re-revascularization (n = 36, group R) and ICU procedures (n = 112, group ICU). Re-revascularizations are mostly blind operations depending on clinical/hemodynamic criteria. These are: no response to resuscitation, recurrent tachycardia/fibrillation, and severe hemodynamic instability after resuscitation. Re-angiography could only be performed in 3.3% of the patients. Event-free survival of the groups was calculated by the Kaplan-Meier method. Events are: death, recurrent angina, myocardial infarction, functional capacity, and reintervention. Results: Seventy percent of patients, who were complicated with cardiac arrest, had perioperative myocardial infarction (PMI). This rate was significantly higher in group R (p = 0.013). The major finding in group R was graft occlusion (91.6%). During in-hospital period, no difference was observed in mortality rates between the two groups. However, hemodynamic stabilization time (p = 0.012), duration of hospitalization (p = 0.00006), and mechanical support use (p = 0.003) significantly decreased by re-revascularization. During the mean 37.1 ± 25.1 months of follow-up period, long-term mortality (p = 0.03) and event-free survival (p = 0.029) rates were significantly in favor of group R. Conclusion: Better short- and long-term results were observed in the re-revascularization group. [source]

Superior Flow Pattern of Internal Thoracic Artery over Saphenous Vein Grafts during OPCAB Procedures

JOURNAL OF CARDIAC SURGERY, Issue 1 2009
Alberto Weber
Methods: Serial intraoperative flow measurements were carried out in 306 consecutive patients (mean age 64 years, mean Euroscore 5.1) undergoing off-pump coronary artery bypass grafting (OPCAB). The LAD was grafted in 302 patients [293 ITA (97%), 9 SV], the Cx in 252 patients [117 ITA (46%), 135 SV], and the RCA in 260 patients [36 ITA (14%), 224 SV]. Results: Averages of 3.7 ± 1.0 distal anastomoses/patient were constructed. Mean pulsatile index (PI) was significantly better for the single ITA/Cx-grafts (2.8 ± 1.9, n = 92) than for the single SV/Cx-grafts (3.3 ± 1.7, n = 43, p < 0.05), whereas the mean flow did not differ (28 ± 22 and 31 ± 25 mL/min respectively, p = ns). Accordingly, the mean PI was significantly better for the single ITA/RCA-grafts (2.2 ± 1.2, n = 36) than for the single SV/RCA-grafts (3.4 ± 2.6, n = 178, p < 0.01), whereas the mean flow did not differ (30 ± 16 and 32 ± 22 mL/min respectively, p = ns). The incidence of perioperative myocardial infarction tended to be lower in patients receiving an ITA to either the Cx or the RCA than in those receiving a SV, but the difference did not reach statistical significance [2/92 of ITA/Cx (2.2%) vs. 2/43 of SV/Cx (4.6%), 1/36 of ITA/RCA (2.8%) vs. 8/178 of SV/RCA (4.5%)]. Conclusion: The internal thoracic artery provides superior flow properties than the SV to the Cx and RCA regions with reduced perioperative ischemia. Whether this advantage persists after adjusting for the grade of the proximal coronary stenosis needs further studies. [source]

Early and Late Outcomes of Multiple Coronary Endarterectomy

JOURNAL OF CARDIAC SURGERY, Issue 6 2008
Minoru Tabata M.D.
However, outcomes of multiple coronary endarterectomy (MCE) have not been well investigated. We sought to examine early and late results of this technique. Methods: Between January 1992 and June 2006, 58 consecutive patients underwent coronary endarterectomy in more than one coronary artery territories, representing 6.5% of total coronary endarterectomy during the same period. Early and late outcomes were retrospectively analyzed. Results: The mean age was 64 years. Forty-one patients (70.7%) had coronary endarterectomy in the left anterior descending artery and right coronary artery territories; five (8.6%) in the left anterior descending artery and circumflex artery territories; eight (13.8%) in the circumflex artery and right coronary artery territories; and four (6.9%) in the left anterior descending artery, circumflex artery, and right coronary artery territories. Operative mortality was 12.1% (7/58). The incidence of perioperative myocardial infarction was 25.9% (15/58). The median length of hospital stay was seven days. Actuarial five- and 10-year survivals were 64% and 36%, respectively. Conclusions: MCE may be a reasonable option for revascularization of multiple diffuse coronary artery disease. However, early and late outcomes are relatively poor and the indication should be carefully considered. [source]

Predictors of Early Outcome After Coronary Artery Surgery in Patients with Severe Left Ventricular Dysfunction

JOURNAL OF CARDIAC SURGERY, Issue 2 2003
Naresh Trehan
The present study was undertaken to identify the prognostic factors in such patients. Methods: We analyzed the data of 176 consecutive patients (161 men, 15 women), aged 29 to 88 years (mean 58.43), with a left ventricular ejection fraction (LVEF) <30% who underwent isolated coronary artery bypass grafting. The LVEF ranged from 15% to 30% (mean 27.18%). Preoperatively, 33% had angina, 19.9% had recent myocardial infarction, and 21.6% had congestive heart failure. The mean number of grafts was 2.5/patient. The intra-aortic balloon was used prophylactically in 20.5% of patients and therapeutically in 4.0% of patients. Results: The hospital mortality was 2.3%. The complications occurred as follows: perioperative myocardial infarction in two (1.1%), intractable ventricular arrhythmias in two (1.1%), prolonged ventilation in four (2.3%) and peritoneal dialysis in 1 (0.6%). The mean ICU and hospital stay were2.46 ± 0.76and7.57 ± 2.24days, respectively. The predictors of survival on univariate analysis were New York Heart Association (NYHA) class(x2 = 14.458, p < 0.001), recent myocardial infarction(x2 = 5.852, p = 0.016), congestive heart failure (CHF)(x2 = 5.526, p = 0.019), and left ventricular end-systolic volume index (LVESVI)(x2 = 25.833, p < 0.001). However, on multivariate analysis, left ventricular end-systolic volume index was the only independent left ventricular function measurement predictive of survival(x2 = 10.228, p = 0.001). Conclusion: Left ventricular end-systolic volume index is the most important predictor of survival after coronary artery bypass surgery in patients with severe myocardial dysfunction.(J Card Surg 2003;18:101-106) [source]

Perioperative myocardial infarction in noncardiac surgery: the diagnostic and prognostic role of cardiac troponins

Postoperative troponin I values: Insult or injury?

CLINICAL CARDIOLOGY, Issue 10 2000
Keith A. Horvath M.D.
Abstract Background: Troponin I (TnI) is increasingly employed as a highly specific marker of acute myocardial ischemia. The value of this marker after cardiac surgery is unclear. Hypothesis: The purpose of this study was to measure serum TnI levels prospectively at 1, 6, and 72 h after elective cardiac operations. In addition, TnI levels were measured from the shed mediastinal blood at 1 and 6 h postoperatively. Serum values were correlated with cross clamp time, type of operation, incidence of perioperative myocardial infarction, as assessed by postoperative electrocardiograms (ECG) and regional wall motion, as documented by intraoperative transesophageal echocardiography (TEE). Methods: Sixty patients underwent the following types of surgery: coronary artery bypass graft (CABG) (n = 45), valve repair/replacement (n = 10), and combination valve and coronary surgery (n = 5). Myocardial protection consisted of moderate systemic hypothermia (30,32°C), cold blood cardioplegia, and topical cooling for all patients. Results: Of 60 patients, 57 (95%) had elevated TnI levels, consistent with myocardial injury, 1 h postoperatively. This incidence increased to 98% (59/60) at 6 h postoperatively. There was a positive correlation between the length of cross clamp time and initial postoperative serum TnI (r = 0.70). There was no difference in the serum TnI values whether or not surgery was for ischemic heart disease (CABG or CABG + valve versus valve). There were no postoperative myocardial infarctions as assessed by serial ECGs. There was no evidence of diminished regional wall motion by TEE. Levels of TnI in the mediastinal shed blood were greater than assay in 58% (35/60) of the patients at 1 h and in 88% (53/60) at 6 h postoperatively. Patients who received an auto-transfusion of mediastinal shed blood (n = 22) had on average a 10-fold postoperative increase in serum TnI levels between 1 and 6 h. Patients who did not receive autotransfusion average less than doubled their TnI levels over the same interval. At 72 h, TnI levels were below the initial postoperative levels but still indicative of myocardial injury. Conclusion: Postoperative TnI levels are elevated after all types of cardiac surgery. There is a strong correlation between intraoperative ischemic time and postoperative TnI level. Further elevation of TnI is significantly enhanced by reinfusion of mediastinal shed blood. Despite these postoperative increases in TnI, there was no evidence of myocardial infarction by ECG or TEE. The postoperative TnI value is even less meaningful after autotransfusion of shed mediastinal blood. [source]