A prospective study of subclinical myocardial damage in endovascular versus open repair of infrarenal abdominal aortic aneurysms

Abraham, Ned; Lemech, Lubomyr; Sandroussi, Charbel; Sullivan, David; May, James R.

doi:10.1016/j.jvs.2004.11.038

Cited by 49 publications

(30 citation statements)

References 31 publications

(53 reference statements)

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“…[9-11, 17, 18]. Ишемию миокарда в периоперационный период диагно-стируют в 21% наблюдений, а повышение уровня тропонина -еще в 15-25% [19][20][21]. Возрастание уровня кардиоспецифических ферментов без со-ответствующих клинических и ýлектрокардиогра-фических признаков называют «малыми повреж-дениями миокарда» [22,23].…”

Section: актуальность проблемы кардиальных ос-ложнений при экстракардunclassified

Prevention of Complications Caused by Myocardial Ischemia-Reperfusion in Noncardiac Surgical Procedures

Kozlov¹

2016

Bûll. sib. med.

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РЕЗЮМЕ В ближайшие 20 лет старение населения станет основным фактором, влияющим на особенности пери-операционной анестезиологической тактики. Отечественные исследователи сообщают, что частота кар-диальных осложнений после общехирургических операций у больных пожилого и старческого возраста составляет 9,1%, а летальность при таких осложнениях достигает 45,5%. Проанализированы современ-ные данные об ишемии-реперфузии миокарда, этиопатогенезе периоперационных кардиальных ослож-нений, цикличности их развития и возможных последствиях. Сделано заключение, что профилактика и своевременное лечение осложнений, обусловленных ишемией-реперфузией миокарда, при экстракарди-альных оперативных вмешательствах является важной тактической (профилактика периоперационного инфаркта миокарда, аритмий, кардиальной смерти) и стратегической (профилактика ремоделирования сердца и постгоспитальной инвалидизации больных) задачей анестезиолога-реаниматолога. Исследо-вание, выполненное в НИИ общей реаниматологии им. В.А. Неговского, показало, что в реальных условиях индекс Detsky, индекс Lee и эхокардиографическая фракция изгнания левого желудочка не обеспечивают высокой точности прогнозирования кардиальных осложнений. Более информативным оказалось предоперационное определение содержания в крови N-терминального отрезка неактивного предшественника BNP (NT-proBNP). При оценке прогностической способности NT-proBNP площадь под ROC-кривой достигла 0,86. Значение NT-proBNP 358 пг/мл и выше обеспечило чувствительность 77% и специфичность 85%. Приводится сравнительная оценка и рекомендации по использованию для сниже-ния риска кардиальных осложнений β-адреноблокаторов, статинов, блокаторов кальциевых каналов, нитратов, клофелина, дексмедетомидина, левосимендана и фосфокреатина. Фосфокреатин, введенный в практику отчественной кардиохирургии и трансплантологии более 20 лет назад, продолжает изучаться и использоваться в настоящее время. Недавно показано, что периоперационное назначение фосфокре-атина онкологическим пожилым больным с высоким риском кардиальных осложнений снижает частоту острой ишемии и делирия, укорачивает длительность пребывания больных в отделении реанимации и интенсивной терапии и общую длительность госпитализации. Сделано заключение, что снижение ча-стоты кардиальных осложнений при экстракардиальных операциях имеет несомненную актуальность.Ключевые слова: ишемия-реперфузия, послеоперационные кардиальные осложнения, инфаркт мио-карда, фармакологическая кардиопротекция, фосфокреатин.

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Section: актуальность проблемы кардиальных ос-ложнений при экстракардunclassified

Prevention of Complications Caused by Myocardial Ischemia-Reperfusion in Noncardiac Surgical Procedures

Kozlov¹

2016

Bûll. sib. med.

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“…Carotid angioplasty with stenting is associated with less perioperative troponin elevation compared with traditional endarterectomy. 53 Endovascular repair of abdominal aortic aneurysm is associated with lower short-term mortality than open repair (4.7% versus 9.8% in-hospital mortality), 54 produces elevations in troponin-T less frequently, 55 but has no effect on long-term mortality. 56,57 Evidence Limitations Few studies provide direct measures of cardiac risks after laparoscopic procedures or endovascular procedures.…”

Section: Laparoscopic and Endovascular Techniquesmentioning

confidence: 99%

Assessing and Reducing the Cardiac Risk of Noncardiac Surgery

2006

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A ccurate estimation of a patient's risk for postoperative cardiac events (eg, myocardial infarction, unstable angina, ventricular tachycardia, pulmonary edema, and death) after noncardiac surgery can guide allocation of clinical resources, use of preventive therapies, and priorities for future research. This review addresses selected issues in clinical risk assessment, approaches to using diagnostic tests, choices among preventive interventions, and postoperative monitoring. Although we have not used a formal systematic

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“…Four million patients per year have been estimated to have a major perioperative cardiovascular complication, including cardiac death, non-fatal myocardial infarction or cardiac arrest 1 . In high-risk patients, the incidence of major perioperative cardiac complications varies from 4 to 25 % depending on patient population and type of surgery [3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

Perioperative myocardial damage and cardiac outcome in patients‐at‐risk undergoing non‐cardiac surgery

Tibblin¹

2010

Acta Anaesthesiol Scand

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Despite increasingly sophisticated perioperative management, cardiovascular complications continue to be major challenges for the clinician. As a growing number of elderly patients with known coronary artery disease (CAD) or with risk factors for CAD are undergoing noncardiac surgery, cardiovascular complications will remain a significant clinical problem in the future. The overall objective of this thesis was to study the incidence of myocardial damage and perioperative adverse cardiac events, to determine predictors of poor outcome and to assess the effect of a medical intervention in patients at risk undergoing non-cardiac surgery. The studies in this thesis were conducted on a total of 952 patients undergoing non-cardiac surgery. Studies I and IV were multicenter studies; whereas the patients included in studies II and III underwent non-cardiac surgery at Linkoping University Hospital, Sweden. The correlation between postoperative myocardial damage and short-and long-term outcome were studied in 546 patients, aged 70 years or older undergoing non-cardiac surgery of at least 30 minutes duration. This study showed a close correlation between postoperative myocardial damage and poor short-as well as long-term outcome. Elevated Troponin T was a strong independent predictor of mortality within one year of surgery. In 186 patients with ASA physical status classification III or IV undergoing non-elective surgery, the incidence of myocardial damage was 33%. In this study preoperative myocardial damage was an independent predictor of major adverse cardiac events in the postoperative period. In 69 patients with ASA physical status classification III & IV undergoing acute hip surgery, we found a close correlation between elevated NT-proBNP value prior to surgery and cardiac complications in the postoperative period. To study the effect of acetylsalicylic acid on postoperative myocardial damage and cardiovascular events, 220 patients at risk were randomized to receive 75 mg of acetylsalicylic acid or placebo 7 days prior to surgery until the third postoperative day. This study showed that treatment with acetylsalicylic acid resulted in an 8% (95% CI 1-15%) absolute risk reduction of having a postoperative major adverse cardiac event. No statistically significant differences of bleeding complications were seen between the groups. In conclusion, this thesis contributes to the understanding of the clinical relevance of elevated cardiac markers (with or without clinical or ECG signs of myocardial damage) in patients undergoing elective or emergency surgery. Moreover, we have identified predictors of poor outcome in the perioperative period that could be used as tools for identifying patients at risk. Finally, we have shown that continuing acetylsalicylic acid in the perioperative period reduced the risk of major adverse cardiac events within 30 days of surgery.

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A prospective study of subclinical myocardial damage in endovascular versus open repair of infrarenal abdominal aortic aneurysms

Abstract: There is a previously underestimated incidence of subclinical myocardial damage associated with surgery for infrarenal AAA which is lower after endovascular than open repair.

Cited by 49 publications

References 31 publications

Prevention of Complications Caused by Myocardial Ischemia-Reperfusion in Noncardiac Surgical Procedures

Prevention of Complications Caused by Myocardial Ischemia-Reperfusion in Noncardiac Surgical Procedures

Assessing and Reducing the Cardiac Risk of Noncardiac Surgery

Perioperative myocardial damage and cardiac outcome in patients‐at‐risk undergoing non‐cardiac surgery

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