Postoperative Arrhythmias in General Surgical Patients

Walsh, Stewart R.; Tang, Tjun Yip; Wijewardena, Chandana; Yarham, Sahah I; Boyle, Jonathan R.; Gaunt, Michael E.

doi:10.1308/003588407x168253

Cited by 87 publications

(77 citation statements)

References 27 publications

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“…For example, the effects of changes in heart rate before, during, and after surgery could elucidate changes in protein expression within the valve. Postoperative arrhythmias occur in up to 20% of patients [18][19][20][21] . The LabVIEW program used for this system allows the user to choose the length of time air enters and leaves the chamber; therefore, the frequency of the cycle can easily be adjusted.…”

Section: Discussionmentioning

confidence: 99%

Design of a Cyclic Pressure Bioreactor for the <em>Ex Vivo</em> Study of Aortic Heart Valves

Schipke

Warnock

2011

JoVE

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The aortic valve, located between the left ventricle and the aorta, allows for unidirectional blood flow, preventing backflow into the ventricle. Aortic valve leaflets are composed of interstitial cells suspended within an extracellular matrix (ECM) and are lined with an endothelial cell monolayer. The valve withstands a harsh, dynamic environment and is constantly exposed to shear, flexion, tension, and compression. Research has shown calcific lesions in diseased valves occur in areas of high mechanical stress as a result of endothelial disruption or interstitial matrix damage(1-3). Hence, it is not surprising that epidemiological studies have shown high blood pressure to be a leading risk factor in the onset of aortic valve disease(4). The only treatment option currently available for valve disease is surgical replacement of the diseased valve with a bioprosthetic or mechanical valve(5). Improved understanding of valve biology in response to physical stresses would help elucidate the mechanisms of valve pathogenesis. In turn, this could help in the development of non-invasive therapies such as pharmaceutical intervention or prevention. Several bioreactors have been previously developed to study the mechanobiology of native or engineered heart valves(6-9). Pulsatile bioreactors have also been developed to study a range of tissues including cartilage(10), bone(11) and bladder(12). The aim of this work was to develop a cyclic pressure system that could be used to elucidate the biological response of aortic valve leaflets to increased pressure loads. The system consisted of an acrylic chamber in which to place samples and produce cyclic pressure, viton diaphragm solenoid valves to control the timing of the pressure cycle, and a computer to control electrical devices. The pressure was monitored using a pressure transducer, and the signal was conditioned using a load cell conditioner. A LabVIEW program regulated the pressure using an analog device to pump compressed air into the system at the appropriate rate. The system mimicked the dynamic transvalvular pressure levels associated with the aortic valve; a saw tooth wave produced a gradual increase in pressure, typical of the transvalvular pressure gradient that is present across the valve during diastole, followed by a sharp pressure drop depicting valve opening in systole. The LabVIEW program allowed users to control the magnitude and frequency of cyclic pressure. The system was able to subject tissue samples to physiological and pathological pressure conditions. This device can be used to increase our understanding of how heart valves respond to changes in the local mechanical environment.

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Section: Discussionmentioning

confidence: 99%

Design of a Cyclic Pressure Bioreactor for the <em>Ex Vivo</em> Study of Aortic Heart Valves

Schipke

Warnock

2011

JoVE

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“…So treten bei ca. 10-40% der kardiound thoraxchirurgischen Patienten postoperative Rhythmusstörungen auf, bei gefäß-und abdominalchirurgischen Eingriffen sind es etwa 4-20% [4,49]. Insgesamt überwiegen deutlich die supraventrikulären Rhythmusstörungen; die häu-figste perioperative Arrhythmie ist das Vorhofflimmern (.…”

Section: Inzidenzunclassified

“…In einigen Studien sind perioperative Arrhythmien mit einer erhöh-ten Mortalitätsrate assoziiert, jedoch bestimmt die zugrunde liegende Erkrankung in der Mehrzahl der Fälle die Prognose [49].…”

Section: Inzidenzunclassified

“…Zu den Risikofaktoren, die das Auftreten perioperativer Arrhythmien begünstigen, zählen fortgeschrittenes Alter (>60 Jahre), Herzrhythmusstörungen in der Vorgeschichte, arterielle Hypertonie, männ-liches Geschlecht und strukturelle Herzerkrankungen (KHK, Vitien, Kardiomyopathie, Herzinsuffizienz; [4,49]). Neben diesen statischen Determinanten gibt es im perioperativen Umfeld eine Reihe dynamischer Komponenten.…”

Section: Prädisponierende Faktorenunclassified

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Amiodaron zur Therapie perioperativer kardialer Rhythmusstörungen

2008

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Cardiac arrhythmias are a common problem in the perioperative period. The incidence found in the current literature varies depending on the population studied and the definition of arrhythmia used. Overall supraventricular arrhythmias, namely atrial fibrillation, are the most common form. Because of its broad spectrum amiodarone is often used to suppress supraventricular and ventricular arrhythmias. It is believed to be safe for treating patients with severe cardiac disease and it has less proarrhyhmogenic potential than many other antiarrhythmic drugs. However, the use of amiodarone is limited by its cardiac and non-cardiac adverse effects, such as life-threatening bradycardia, pulmonary fibrosis or thyrotoxicosis. According to the guidelines of the American Heart Association, amiodarone can be used to treat atrial fibrillation. Because spontaneous conversion rates in the perioperative setting are high and the advantage of a rhythm control strategy over rate control is questionable, a rate control strategy using less toxic drugs like beta blockers or calcium channel blockers should be preferred in hemodynamically stable patients. The current guidelines of the European Resuscitation Council (ERC) recommend amiodarone to treat hemodynamically stable ventricular tachycardia and in this setting ajmaline is also highly effective. Amiodarone should be administered to patients with cardiac arrest if ventricular tachycardia or ventricular fibrillation persists after three attempts at defibrillation. Dronedarone is a derivate of amiodarone with a similar mechanism of action but with less non-cardiac side effects and is currently being tested in clinical trials. The use of the atrial-specific potassium channel blockers AZD7009 and vernakalant are also being investigated. Furthermore, the role of statins, ACE inhibitors and angiotensin receptor blockers in the prevention of atrial fibrillation has to be evaluated.

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“…Within this context, it is associated with the presence of comorbidities, longer hospital stays and higher surgery-related costs [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

Fibrilação atrial no pós-operatório de cirurgia cardíaca

Ferro¹,

Oliveira²,

Nunes³

et al. 2009

Arq. Bras. Cardiol.

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SummaryAtrial fibrillation (AF) is an arrhythmia frequently seen in the postoperative period of cardiac surgery. In this context, it is associated with the presence of comorbidities, longer length of hospital stay, and higher costs related to surgery.The mechanisms involved in the genesis of AF in the postoperative period of cardiac surgery (AFPO) are different from those causing paroxysmal AF. Knowledge of these mechanisms permits the use of efficient measures to reduce the incidence of this arrhythmia.According to recommendations of the literature, treatment is efficient and safe, because the rates of reversion to sinus rhythm are high and complications are reduced, and it is not associated with a high frequency of side effects.

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Postoperative Arrhythmias in General Surgical Patients

Cited by 87 publications

References 27 publications

Design of a Cyclic Pressure Bioreactor for the <em>Ex Vivo</em> Study of Aortic Heart Valves

Design of a Cyclic Pressure Bioreactor for the <em>Ex Vivo</em> Study of Aortic Heart Valves

Amiodaron zur Therapie perioperativer kardialer Rhythmusstörungen

Fibrilação atrial no pós-operatório de cirurgia cardíaca

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