Postoperative Hyponatremia Predicts an Increase in Mortality and In-Hospital Complications after Cardiac Surgery

Crestanello, Juan A.; Phillips, Gary; Firstenberg, Michael S.; Sai-Sudhakar, Chittoor; Sirak, John; Higgins, Robert S.D.; Abraham, William T.

doi:10.1016/j.jamcollsurg.2013.02.010

Cited by 28 publications

(24 citation statements)

References 26 publications

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“…Our study suggests that age, sex, BSA, EF and cardiac risk factors did not have any significant differences between groups. Previous studies are in concordance with our study however some provide information with correlation between serum sodium levels and EF (6,16). In the present study, the two studied groups revealed no significant differences between intraoperative values such as CPB, clump, and surgery time, mechanical ventilation, ICU admission and complications during off pump.…”

Section: Discussionsupporting

confidence: 93%

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Association of Perioperative Serum Sodium Level Fluctuation and Postoperative Complications in Coronary Artery Bypass Graft Surgery

Azarfarin

Shekoohi

Totonchi

et al. 2017

Multidiscip CardioAnnal

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Background: Electrolyte abnormalities are common in coronary artery bypass graft surgery (CABG) using cardiopulmonary bypass (CPB). Changes in serum sodium (Na) concentration more than 15 meq/L in perioperative period (Delta Na > 15) is considered as significant fluctuation. The aim of this study was evaluating the relationship between the significant fluctuation of serum Na level and the complications after coronary artery bypass graft surgery. Methods: In this prospective observational study 59 patients who were candidates for CABG with CPB were enrolled into the study. We recorded patients' demographic data, arterial blood gas analysis (ABG), serum electrolytes including Na levels from anesthesia induction, during and after CPB up to 24 hours after admission in ICU. Postoperative complications until discharge from ICU were compared between patients with significant Na fluctuation and those without it.Results: Thirty-nine patients had serum sodium fluctuation equal and more than 15 mEq/L (Delta Na ≥ 15 group). This group was compared with those who had minor Na variation (Delta Na < 15; n = 20). The Na > 15 mEq/L fluctuation group had higher serum Na and lactate levels, lower base excess in ABG. Patients with at least one postoperative complication, were older and had lower ejection fraction and more sodium fluctuations. Logistic regression analysis showed that serum sodium fluctuation more than 15mEq/l was independently associated with post CABG complications. Conclusions: Perioperative serum sodium fluctuation more than 15mEq/L was independently associated with postoperative complications in patients undergoing CABG.

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Section: Discussionsupporting

confidence: 93%

“…One of the important electrolytes in this field is sodium. Sodium is an important electrolyte in blood pressure maintenance in normal ranges and also the proper function of nerves in muscles (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Association of Perioperative Serum Sodium Level Fluctuation and Postoperative Complications in Coronary Artery Bypass Graft Surgery

Azarfarin

Shekoohi

Totonchi

et al. 2017

Multidiscip CardioAnnal

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“…11,[15][16][17][18][19] It also is associated with increased mortality in these conditions 9,15,16 and in cardiac surgery patients. [12][13][14] Destination or bridging therapy with an implantable LVAD has become an increasingly common procedure for patients with severe, chronic systolic heart failure. Many of these patients have co-existing hyponatremia and present to the operating room for surgery without correction.…”

Section: Discussionmentioning

confidence: 99%

“…9 Similar relationships have been found in cardiac surgery patients, with preoperative, postoperative, and ICU-acquired sodium disturbances all being associated with higher mortality. [12][13][14] To the authors' knowledge, there are no published studies of hyponatremia and outcomes in patients after LVAD implantation. The objective of this study was to examine the effect of preoperative hyponatremia and perioperative sodium changes on 30-day mortality and adverse postoperative neurologic events in patients undergoing durable LVAD implantation.…”

mentioning

confidence: 99%

Moderate-to-Large Increases in Perioperative Serum Sodium Concentration Associated With Adverse Neurologic Events After Continuous Flow Left Ventricular Assist Device Implantation

Mazzeffi

Paciullo

Vega

et al. 2015

Journal of Cardiothoracic and Vascular Anesthesia

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“…Hal ini berkaitan dengan ketahanan jangka panjang valve repair yang terbatas, Crestanello, dkk. 23 melakukan penelitian mengenai hal ini dan didapatkan angka operasi ulang pada pasien yang telah dilakukan valve repair sebanyak 16%. Pada beberapa kasus stenosis aorta yang berat, transcatheter aortic calve implatation merupakan pilihan terapi yang baik.…”

Section: Tata Laksana Komprehensifunclassified

Kardiotoksisitas Akibat Terapi Radiasi

Wisman¹,

Nasution²,

Panggabean³

2017

JPDI

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ABSTRAKTerapi radiasi merupakan suatu modalitas penting dalam tata laksana pasien keganasan. Beberapa kasus keganasan yang memerlukan terapi radiasi pada bagian dada yaitu kanker payudara, limfoma Hodgkin, ataupun kanker paru. Kardiotoksisitas akibat terapi radiasi dapat terjadi dalam waktu 3 sampai dengan 29 tahun setelah terapi radiasi dan umumnya terjadi pada dekade kedua atau dekade ketiga setelah terapi. Beberapa komplikasi kardiovaskuler akibat terapi radiasi dapat mengenai perikardial, miokardial, vaskuler, katup jantung, dan gangguan konduksi. Kardiotoksisitas yang bergejala dapat terjadi pada 10% pasien yang menjalani terapi radiasi di daerah dada dengan komplikasi kardiovaskuler. Penting bagi klinisi untuk memahami mengenai kardiotoksisitas pada terapi radiasi untuk kepentingan edukasi, pertimbangan terapi dan dosis, pemantauan terapi dan deteksi dini. Deteksi dini dan pemantauan paska radiasi memiliki peranan penting untuk mengurangi morbiditas dan mortalitas karena penyakit jantung akibat paparan radiasi. Penatalaksanaan komprehensif sangat diperlukan. PENDAHULUANTerapi radiasi merupakan suatu modalitas penting dalam tata laksana pasien keganasan yang mana sekitar 50% dari pasien keganasan mendapatkan terapi ini. 1 Terdapat peningkatan angka harapan hidup pada pasien kanker yang mendapatkan terapi radiasi. Pada kasus kanker payudara yang diberikan terapi radiasi setelah menjalani operasi, didapatkan penurunan risiko rekurensi sebesar 50% dan risiko kematian akibat kanker berkurang sebesar 17%. Namun, radiasi juga dapat menyebabkan komplikasi kardiovaskuler pada pasien yang menjalani terapi. [1][2][3] Dalam suatu penelitian rektrospektif yang dilakukan di Stanford University pada pasien yang mendapatkan terapi radiasi untuk kasus limfoma hodgkin, didapatkan risiko relatif infark miokard sebesar 41,5 dibandingkan dengan populasi umum. 4 Penelitian tesebut juga melaporkan bahwa risiko henti jantung meningkat pada pasien yang mendapat terapi radiasi mediastinal dengan dosis >30 Gy dan meningkat seiring dengan peningkatan dosis. Pada studi metanalisis dari 40 randomized clinical trial yang membandingkan antara terapi radiasi dengan dan tanpa terapi radiasi pada pasien kanker payudara, didapatkan penurunan risiko kematian akibat kanker payudara. Namun, pada studi tersebut ditemukan bahwa risiko kematian akibat penyakit vaskuler meningkat. 5

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Postoperative Hyponatremia Predicts an Increase in Mortality and In-Hospital Complications after Cardiac Surgery

Cited by 28 publications

References 26 publications

Association of Perioperative Serum Sodium Level Fluctuation and Postoperative Complications in Coronary Artery Bypass Graft Surgery

Association of Perioperative Serum Sodium Level Fluctuation and Postoperative Complications in Coronary Artery Bypass Graft Surgery

Moderate-to-Large Increases in Perioperative Serum Sodium Concentration Associated With Adverse Neurologic Events After Continuous Flow Left Ventricular Assist Device Implantation

Kardiotoksisitas Akibat Terapi Radiasi

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