Postoperative complications in cardiac patients undergoing noncardiac surgery

Hert, Stefan De; Moerman, Anneliese; Baerdemaeker, Luc De

doi:10.1097/mcc.0000000000000315

Cited by 14 publications

(4 citation statements)

References 91 publications

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“…Adverse Discharge After TAVR Versus SAVR underlines the inherent risk difference of a minimally invasive procedure compared to open-heart surgery in a population with increased risk for cardiovascular morbidity. 39,40 Our study adds information about the beneficial association of a shorter procedural duration on a patient's discharge disposition when utilizing TAVR compared to SAVR.…”

Section: Anesthesia and Analgesiamentioning

confidence: 95%

Loss of Independent Living in Patients Undergoing Transcatheter or Surgical Aortic Valve Replacement: A Retrospective Cohort Study

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Robitaille

Wachtendorf

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: The recommendation for transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) in patients 65 to 80 years of age is equivocal, leaving patients with a difficult decision. We evaluated whether TAVR compared to SAVR is associated with reduced odds for loss of independent living in patients ≤65, 66 to 79, and ≥80 years of age. Further, we explored mechanisms of the association of TAVR and adverse discharge. METHODS: Adult patients undergoing TAVR or SAVR within a large academic medical system who lived independently before the procedure were included. A multivariable logistic regression model, adjusting for a priori defined confounders including patient demographics, preoperative comorbidities, and a risk score for adverse discharge after cardiac surgery, was used to assess the primary association. We tested the interaction of patient age with the association between aortic valve replacement (AVR) procedure and loss of independent living. We further assessed whether the primary association was mediated (ie, percentage of the association that can be attributed to the mediator) by the procedural duration as prespecified mediator. RESULTS: A total of 1751 patients (age median [quartiles; min–max], 76 [67, 84; 23–100]; sex, 56% female) were included. A total of 27% (222/812) of these patients undergoing SAVR and 20% (188/939) undergoing TAVR lost the ability to live independently. In our cohort, TAVR was associated with reduced odds for loss of independent living compared to SAVR (adjusted odds ratio [ORadj] 0.19 [95% confidence interval {CI}, 0.14–0.26]; P < .001). This association was attenuated in patients ≤65 years of age (ORadj 0.63 [0.26–1.56]; P = .32) and between 66 and 79 years of age (ORadj 0.23 [0.15–0.35]; P < .001), and magnified in patients ≥80 years of age (ORadj 0.16 [0.10–0.25]; P < .001; P-for-interaction = .004). Among those >65 years of age, a shorter procedural duration mediated 50% (95% CI, 28–76; P < .001) of the beneficial association of TAVR and independent living. CONCLUSIONS: Patients >65 years of age undergoing TAVR compared to SAVR had reduced odds for loss of independent living. This association was partly mediated by shorter procedural duration. No association between AVR approach and the primary end point was found in patients ≤65 years of age.

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Section: Anesthesia and Analgesiamentioning

confidence: 95%

Loss of Independent Living in Patients Undergoing Transcatheter or Surgical Aortic Valve Replacement: A Retrospective Cohort Study

Blank

Robitaille

Wachtendorf

et al. 2023

Anesthesia &Amp; Analgesia

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“…It seems that perioperative statin therapy is associated with a lower incidence of postoperative myocardial infarction in non-cardiac surgery but not in cardiac surgery. The pathophysiology of perioperative myocardial ischemia is different in non-cardiac 95 and cardiac surgery, which may explain the discrepant results between the two surgical groups.…”

Section: Agingmentioning

confidence: 99%

New advances in perioperative cardioprotection

Momeni

Hert

2019

F1000Res

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With the increasing age of the general population, medical conditions necessitating a surgical intervention will increase. Concomitant with advanced age, the prevalence of type 2 diabetes mellitus will also increase. These patients have a two- to three-fold higher risk of occurrence of cardiovascular events and are at higher risk of perioperative myocardial ischemia. This review will discuss recent advances in the field of perioperative cardioprotection and focus specifically on strategies that have aimed to protect the diabetic and the aged myocardium. This review will not deal with potential putative cardioprotective effects of opioids and anesthetic agents, as this is a very broad area that would necessitate a dedicated overview.

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“…Zugrunde liegt hier ein myokardiales Missverhältnis zwischen erhöhtem Sauerstoffbedarf und vermindertem Sauerstoffangebot: Der myokardiale O 2 -Bedarf ist sympathikusvermittelt bei mechanischer Beatmung, chirurgischem Trauma, Gewebehypo-und -reperfusion, der Gabe von Blutprodukten sowie postoperativen Schmerzen gesteigert [3]. Das myokardiale O 2 -Angebot hingegen wird reduziert durch Hypotension und Anämie infolge perioperativer Blutverluste sowie durch eine inflammatorisch bedingte prothrombogene Gerinnungslage, die u. a. in der Lungen-und Koronarstrombahn thrombembolische Ereignisse begünstigt [4].…”

Section: Kardiovaskuläres Risikounclassified