Implications of obesity in cardiac surgery: pattern of referral, physiopathology, complications, prognosis

Santo, Luca Salvatore De; Moscariello, Caesar; Zebele, Carlo

doi:10.21037/jtd.2018.06.104

Cited by 35 publications

(41 citation statements)

References 38 publications

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“…Obesity is also considered as an effective factor in the incidence of cardiovascular disease as well as pulmonary diseases. A review of various studies has shown that the incidence of PC following CABG surgery in obese patients is significantly higher than in other patients [28], but some studies have reported that the body mass index (BMI) of patients with and without PC was similar and the mean BMI in both groups was not statistically significant [26]. Diabetes mellitus (DM) as a prevalent underlying disease in different societies has always been a factor in the occurrence of varied morbidity and mortality.…”

Section: Preoperative Factorsmentioning

confidence: 99%

Pulmonary complications following cardiac surgery

Mali¹,

Haghaninejad²

2019

Arch Med Sci Atheroscler Dis

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Coronary heart disease is a common diseases of atherosclerosis. Despite the development of noninvasive therapies and the advancement of pharmacological methods and extensive drug regimens, coronary artery bypass grafting surgery is still the ultimate treatment option in many patients. Among the various complications following open heart surgery, one of the common difficulties is pulmonary complications associated with subsequent morbidity and mortality, which should be studied according to preoperative, perioperative, and postoperative factors. Preoperative factors include genetics, age, family history of pulmonary disease, smoking, coexisting disease, etc. Perioperative factors include surgical procedures like sternotomy incision, cardioplegia, and internal mammary artery harvesting; anaesthesia procedure effects like pulmonary collapse, maintenance drugs and morphine administration; and cardiopulmonary bypass pump by systemic inflammatory response syndromes. And finally, postoperative factors, especially mediastinitis and the role of nursing in the intensive care unit. Pulmonary complications after cardiac surgery include atelectasis, pleural effusions, pneumonia, pulmonary oedema, cardiogenic pulmonary oedema, acute respiratory distress syndrome, pulmonary embolism, phrenic nerve injury, pneumothorax, sternal wound infection, and mediastinitis, with different outbreaks in patients reported. Although the preoperative, perioperative, and postoperative factors play an important role in the occurrence of these complications, the preoperative factors, as factors that can be adjusted, should be considered more than the others and explained to the patient, and the preoperative patient's assessment should be noted. Also, postoperative care with the goal of reducing infections and pulmonary complications should be addressed by the nursing team.

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Section: Preoperative Factorsmentioning

confidence: 99%

Pulmonary complications following cardiac surgery

Mali¹,

Haghaninejad²

2019

Arch Med Sci Atheroscler Dis

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“…Kalp cerrahisi sonrası hasta sonuçlarını etkileyen önemli komplikasyonlardan biri de postoperatif böbrek yetmezliğidir ve literatürde sıklığının obezite ile arttığı, ancak diyaliz gereksiniminde anlamlı fark olmadığı gösterilmiştir [5,13,[15][16][17] . Mekanizması net olmasa da, değişen renin-anjiotensin-aldesteron sistemi, kronik inflamasyon, metabolik sendrom ve preoperatif HT/DM gibi komorbiditelerin varlığı suçlanmaktadır [5,16,17] . Sonuçlarımız da literatürle benzer şekilde postoperatif obez grupta renal yetmezlik insidansı yüksek, dializ gereksinimi benzer bulundu.…”

Section: Discussionunclassified

“…Yine iki farklı çalışmada da, obez olgularda kanama komplikasyonu ve buna bağlı re-operasyon oranlarının daha az olduğu gösterilmiştir [15,18] . Pek çok çalışmada obezitenin daha az kanamayla ilişkisi gösterilmiş ve bunun nedeni olarak, mediastende biriken büyük miktardaki yağ dokusu ve yüksek intraabdominal basıncın, intratorasik basıncı arttırarak kanama alanlarında kompresyon etkisi yaratması, açıklık kazanmasa da obeziteye bağlı hiperkoagülopatik durum ve daha az hemodilüsyon gereksinimi olarak bildirilmiştir [5,[13][14][15]17,18] . Bizim çalışmamızda da postoperatif drenaj miktarları benzer olsa da tamponad ve kanama sebepli cerrahi gereksinim obez grupta daha azdı.…”

Section: Discussionunclassified

See 1 more Smart Citation

Impact of High Body Mass Index on Morbidity and Mortality ın Cardiac Surgery Cardiac Surgery and Obesity

Özcan¹,

Demirgan²,

Abdullah³

et al. 2020

GKDA Derg

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Objective: In this study, we evaluated the effects of body mass index on mortality and morbidity after cardiac surgery. Method: The record of 813 patients who performed open-heart surgery in our clinic were retrospectively analyzed. 505 patients with complete records were included in the study. Postoperative mortality and morbidity developments were compared in patients with a body mass index of (BMI) ≥30 kg/m 2 and BMI ≤30 kg/m 2 from the records. Results: 389 (%70) of patients were BMI < 30 kg/m 2 , non-obese (Group N), 166 of them were BMI ≥30 kg/m 2 , obese (Group OB). The mean age of groups (59.2±12.5, 59.6±9.6 years, respectively, p=0.65) was similar. Female gender, Diabetes Mellitus (DM), hypertension, hyperlipidemia were more common in Group OB (p<0.05). Intraoperative cardiopulmonary bypass (101±43, 98±42 p=0.26) and the duration of aortic cross clamp (64±32.7, 61.6±32.5 p=0.21) were similar. Post-operative complications of pulmonary (%19, %10) and renal (%13, %9) were significantly higher in Group OB (p<0.05), tamponade (%3.1, %0.6) and bleeding revision (%5.7, %1.8) were higher in Group N (p<0.05). Mortality occurred in 27 (5%) patients after surgery. There was no significant difference between mortality rates, ICU and hospital stay (p<0.05). Conclusion: High BMI (≥30 kg/m 2) is associated with respiratory system and renal complications after cardiac surgery, and low BMI (< 30 kg/m 2) is associated with morbidities such as tamponade and bleeding revision.

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“…Current estimates suggest that >35% of patients undergoing heart surgery are obese (body mass index (BMI) >30 kg/m 2 ) ( 1 ). Obesity is causally linked to the development of IR and T2DM which increases the risk for cardio metabolic disorders ( 2 – 4 ) as well as susceptibility of re-hospitalization ( 5 , 6 ). Predicting relapses of post-operative complications in obese patients who undergo cardiac surgery is significantly complicated by persistent metabolic maladaptation associated with obesity, such as increases in circulating lipids, glucose, adipocytokines (leptin, insulin, RBP4) and branch chain amino acids (BCAAs).…”

Section: Introductionmentioning

confidence: 99%

Adverse Outcomes in Obese Cardiac Surgery Patients Correlates With Altered Branched-Chain Amino Acid Catabolism in Adipose Tissue and Heart

et al. 2020

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Background: Predicting relapses of post-operative complications in obese patients who undergo cardiac surgery is significantly complicated by persistent metabolic maladaptation associated with obesity. Despite studies supporting the linkages of increased systemic branched-chain amino acids (BCAAs) driving the pathogenesis of obesity, metabolome wide studies have either supported or challenged association of circulating BCAAs with cardiovascular diseases (CVDs). Objective: We interrogated whether BCAA catabolic changes precipitated by obesity in the heart and adipose tissue can be reliable prognosticators of adverse outcomes following cardiac surgery. Our study specifically clarified the correlation between BCAA catabolizing enzymes, cellular BCAAs and branched-chain keto acids (BCKAs) with the severity of cardiometabolic outcomes in obese patients pre and post cardiac surgery. Methods: Male and female patients of ages between 44 and 75 were stratified across different body mass index (BMI) (non-obese = 17, pre-obese = 19, obese class I = 14, class II = 17, class III = 12) and blood, atrial appendage (AA), and subcutaneous adipose tissue (SAT) collected during cardiac surgery. Plasma and intracellular BCAAs and BC ketoacids (BCKAs), tissue mRNA and protein expression and activity of BCAA catabolizing enzymes were assessed and correlated with clinical parameters. Results: Intramyocellular, but not systemic, BCAAs increased with BMI in cardiac surgery patients. In SAT, from class III obese patients, mRNA and protein expression of BCAA catabolic enzymes and BCKA dehydrogenase (BCKDH) enzyme activity was decreased. Within AA, a concomitant increase in mRNA levels of BCAA metabolizing enzymes was observed, independent of changes in BCKDH protein expression or activity. BMI, indices of tissue dysfunction and duration of hospital stay following surgery correlated with BCAA metabolizing enzyme expression and metabolite levels in AA and SAT. Conclusion: This study proposes that in a setting of obesity, dysregulated BCAA catabolism could be an effective surrogate to determine cardiac surgery outcomes and plausibly predict premature re-hospitalization.

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Implications of obesity in cardiac surgery: pattern of referral, physiopathology, complications, prognosis

Cited by 35 publications

References 38 publications

Pulmonary complications following cardiac surgery

Pulmonary complications following cardiac surgery

Impact of High Body Mass Index on Morbidity and Mortality ın Cardiac Surgery Cardiac Surgery and Obesity

Adverse Outcomes in Obese Cardiac Surgery Patients Correlates With Altered Branched-Chain Amino Acid Catabolism in Adipose Tissue and Heart

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