Preoperative, Multidisciplinary Clinical Optimization of Patients with Severely Depressed Left Ventricular Ejection Fraction Who Are Undergoing Coronary Artery Bypass Grafting

Shehata, Islam Mohammad; Odell, Tiffany; Elhassan, Amir; Spektor, Maxim; Urits, Ivan; Viswanath, Omar; Jeha, George M.; Cornett, Elyse M.; Kaye, Alan D.

doi:10.1007/s40119-020-00207-1

Cited by 2 publications

(2 citation statements)

References 36 publications

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“…Patients undergoing CABG who have a reduced left ventricular function incur higher mortality risks than those with a preserved ventricular function [9,16]. Indicators of frailty in this population such as anaemia, reduced mobility and nutritional deficiencies are common [9].…”

Section: Depressed Ventricular Functionmentioning

confidence: 99%

“…Indicators of frailty in this population such as anaemia, reduced mobility and nutritional deficiencies are common [9]. Under the care of a cardiology clinician, medical therapy [angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers, aldosterone antagonists, angiotensin receptor neprilysin inhibitors (ARNI) and sodium-glucose cotransporter-2 (SGLT2) inhibitors] should be titrated to achieve target doses [16]. Noting the contribution of some of these drugs (ACEI, ARB and ARNI) to adverse haemodynamic consequences and euglycemic ketoacidosis (with SGLT2-I) in the perioperative period, discontinuation of these agents 2--3 days prior to surgery should be carefully considered [9].…”

Section: ‘High Impact’ Areas For Preoperative Optimization Of Patient...mentioning

confidence: 99%

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Preoperative optimization and rapid discharge after coronary artery bypass grafting

Ponnambalam,

Alex

2023

Current Opinion in Cardiology

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Purpose of review This review discusses current guidelines and evidence-based care for the preoperative optimization of patients who are undergoing coronary artery bypass grafting (CABG) and for enabling rapid discharge after surgery. Recent findings Since the Enhanced Recovery After Cardiac Surgery Society (ERAS Cardiac) issued guidelines for perioperative care, in 2019, there has been a significant body of research that has added to and provided further guidance regarding preoperative optimization and accelerated recovery after CABG. Summary A review of the current literature provides a framework for a pragmatic approach to preoperative optimization, utilizing the time from referral to surgery to mitigate multiple aspects of the patient condition, leading to improved patient outcomes and reduced length of stay and cost to the healthcare system.

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Section: Depressed Ventricular Functionmentioning

confidence: 99%

Section: ‘High Impact’ Areas For Preoperative Optimization Of Patient...mentioning

confidence: 99%

Preoperative optimization and rapid discharge after coronary artery bypass grafting

Ponnambalam,

Alex

2023

Current Opinion in Cardiology

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Determination of comorbidity index for high-risk patients with coronary artery disease before cardiac surgery

Gogayeva¹

2021

ZMJ

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The aim: to determine the comorbidity index before cardiac surgery in high-risk patients with coronary artery disease (CAD). Materials and methods. A retrospective analysis of data from 354 random high-risk patients who underwent a surgery and were discharged from National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine during the period 2009–2019. The mean age of patients was 61.9 ± 9.6 years. All the patients were examined: ECG, ECHO CG, coronary angiography before the surgery as well as Charlson comorbidity index was calculated and a risk on the scales EuroSCORE I, EuroSCORE II and STS was stratified. Results. I–III degree obesity was revealed in 133 (37.5 %) patients, patients with type 2 diabetes mellitus (DM) were more likely to have BMI >30 kg/m2 (P = 0.017). Patients with normal weight had a carotid artery stenosis >50 % (P = 0.014) and history of stroke (P = 0.043) significantly more frequently. No differences in comorbidity of overweight and normal weight patients were detected (5.73 ± 1.70 vs. 5.9 ± 1.8, P = 0.4638). Type 2 DM was diagnosed in 90 (25.4 %) patients. In the case of normoglycemia, the comorbidity index was significantly lower than in type 2 DM (4.88 ± 1.38 vs. 6.60 ± 2.03, P = 0.0001) and glucose intolerance 5.8 ± 1.5 (P < 0.0001). Chronic kidney disease (CKD) G3a–G4 stages was diagnosed in 132 (37.2 %) patients. Significant higher comorbidity was found in patients with G3a–G4 stages CKD in comparison to those with G1–G2 stages CKD – 6.33 ± 1.78 vs. 5.46 ± 1.60 (P < 0.0001). Among comorbidities in patients with gouty arthritis, type 2 DM (P < 0.0001), obesity (P = 0.0080), CKD G3a–G4 (P = 0.0020) and varicose veins of the lower extremities (P = 0.0214) were significantly more common. Preoperative risk stratification according to the EuroSCORE II scale averaged 8.8 %. Conclusions. Preoperative analysis of baseline status in CAD patients showed the high Charlson comorbidity index, which averaged 5.7 ± 1.7. The weak direct correlation between the comorbidity index and the high predicted cardiac risk on the ES II scale (r = 0.2356, P = 0.00001), length of stay in the intensive care unit (r = 0.1182, P = 0.0262) and discharge after the surgery (r = 0.1134, P = 0.0330) was found.

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Preoperative, Multidisciplinary Clinical Optimization of Patients with Severely Depressed Left Ventricular Ejection Fraction Who Are Undergoing Coronary Artery Bypass Grafting

Cited by 2 publications

References 36 publications

Preoperative optimization and rapid discharge after coronary artery bypass grafting

Preoperative optimization and rapid discharge after coronary artery bypass grafting

Determination of comorbidity index for high-risk patients with coronary artery disease before cardiac surgery

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