Assessing and minimization of perioperative risk in cardiologic patient in non-cardiac surgery

Authors

DOI:

https://doi.org/10.22141/2224-0586.4.99.2019.173926

Keywords:

non-cardiac surgery, perioperative risk, periope­rative drug therapy, review

Abstract

The article describes perioperative evaluation of patients in whom cardiac disease can cause complications during non-cardiac surgery. The paper is based on the data from last guidelines on cardiovascular assessment and management during non-cardiac surgery which were published by the European Society of Cardiology and the European Society of Anesthesio­logy (2014), American College of Cardiology and American Heart Association (2014), and the Canadian Cardiovascular Society (2017). Heart complications during non-cardiac surgery depend both on patient-related and surgical risk factors. The patient should be evaluated step-by-step. It should be taken into the account the urgency and type of surgery; the risk of the surgical procedure (Lee score, NSQIP MICA model), all active or unstable cardiac conditions and cardiac risk factors should be evaluated, as well as the functional capacity of a patient to be determined. In certain circumstances, the multidisciplinary team should be involved in individualized perioperative management of a patient. Non-invasive stress-tests should be performed in some cases to stratify a risk for a patient. Optimal medical treatment and ever coronary revascularization should be considered to stabilize a patient and predict adverse outcome. The article highlights risk reduction strategy by perioperative management with cardiologic medications. The authors emphasized advantages of continuation of beta-blockers usage at the day of surgery. The paper describes the management of patients taking chronic anti-platelet agents and anticoagulants, including bridge therapy with heparins in persons taking oral anticoagulants. Few clinical cases of perioperative evaluation are presented to highlight the practical implementation of step-by-step perioperative evaluation of a patient.

Downloads

Download data is not yet available.

References

Duceppe E., Parlow J., MacDonald P. et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. The Canadian Journal of Cardiology. 2017. 33(1). Р. 17-32. doi: 10.1016/j.cjca.2016.09.008.

Botto F., Alonso-Coello P., Chan M.T. et al. Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes. Anesthesiology. 2014. 120. Р. 564-578. doi: 10.1097/ALN.0000000000000113.

Naughton C., Feneck R.O. The impact of age on 6-month survival in patients with cardiovascular risk factors undergoing elective non-cardiac surgery. The International Journal of Clinical Practice. 2007. 61. Р. 768-776. doi: 10.1111/j.1742-1241.2007.01304.x.

Carroll K., Majeed A., Firth C., Gray J. Prevalence and management of coronary heart disease in primary care: population-based cross-sectional study using a disease register. Journal of Public Health Medicine. 2003. 25(1). Р. 29-35. PMID: 12669915.

Kristensen S.D., Knuuti J., Saraste A. et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). European Heart Journal. 2014. 35(35). Р. 2383-2431. doi: 10.1093/eurheartj/ehu282.

Fleisher L.A., Fleischmann K.E., Auerbach A.D. et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardio­logy/American Heart Association Task Force on Practice Guidelines. Circulation. 2014. 130(24). Р. 2215-2245. doi: 10.1161/CIR.0000000000000105.

Glance L.G., Lustik S.J., Hannan E.L., Osler T.M., Mukamel D.B. The Surgical Mortality Probability Model: Derivation and Validation of a Simple Risk Prediction Rule for Noncardiac Surgery. Annals of Surgery. 2012. 255(4). Р. 696-702. doi: 10.1097/SLA.0b013e31824b45af.

Lee T.H., Marcantonio E.R., Mangione C.M. et al. Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery. Circulation. 1999. 100(10). Р. 1043-1049. doi: 10.1161/01.CIR.100.10.1043.

Gupta P.K., Gupta H., Sundaram A. et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011. 124(4). Р. 381-387. doi: 10.1161/CIRCULATIONAHA.110.015701.

Le Manach Y., Ibanez Esteves C., Bertrand M. et al. Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing vascular surgery. Anesthesiology. 2011. 114(1). Р. 98-104. doi: 10.1097/ALN.0b013e31820254a6.

McNally M.M., Agle S.C., Parker F.M., Bogey W.M., Powell C.S., Stoner M.C. Preoperative statin therapy is associated with improved outcomes and resource utilization in patients undergoing aortic aneurysm repair. Journal of Vascular Surgery. 2010. 51(6). Р. 1390-1396. doi: 10.1016/j.jvs.2010.01.028.

Verzini F., De Rango P., Parlani G. et al. Effects of statins on early and late results of carotid stenting. Journal of Vascular Surgery. 2011. 53(1). Р. 71-79; discussion 79. doi: 10.1016/j.jvs.2010.08.024.

Devereaux P.J., Sessler D.I., Leslie K. et al. Clonidine in patients undergoing noncardiac surgery. The New England Journal of Medicine. 2014. 370(16). Р. 1504-1513. doi: 10.1056/NEJMoa1401106.

Burger W., Chemnitius J.M., Kneissl G.D., Rucker G. Low-dose aspirin for secondary cardiovascular prevention — cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation — review and meta-analysis. Journal of Internal Medicine. 2005. 257(5). Р. 399-414. doi: 10.1111/j.1365-2796.2005.01477.x.

Kaluza G.L., Joseph J., Lee J.R., Raizner M.E., Raizner A.E. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. Journal of the American College of Cardio­logy. 2000. 35(5). Р. 1288-1294. PMID: 10758971.

Valgimigli M., Bueno H., Byrne R.A., Collet J.P. et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2018. 39(3). Р. 213-260. doi: 10.1093/eurheartj/ehx419.

Gro Egholm, Steen Dalby Kristensen, Troels Thim et al. Risk Associated With Surgery Within 12 Months After Coronary Drug-Eluting Stent Implantation. Journal of the American College of Cardiology. 2016. 68(24). Р. 2622-2632. doi: 10.1016/j.jacc.2016.09.967.

Holcomb C.N., Graham L.A., Richman J.S., Itani K.M., Maddox T.M., Hawn M.T. The Incremental Risk of Coronary Stents on Postoperative Adverse Events: A Matched Cohort Study. Annals of Surgery. 2016. 263(5). Р. 924-930. doi: 10.1097/SLA.0000000000001246.

Vahanian A., Alfieri O., Andreotti F. et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Journal of Cardio-Thoracic Surgery. 2012. 42(4). Р. S1-44. doi: 10.1093/ejcts/ezs455.

Pengo V., Cucchini U., Denas G. et al. Standardized Low-Molecular-Weight Heparin Bridging Regimen in Outpatients on Oral Anticoagulants Undergoing Invasive Procedure or Surgery, An Inception Cohort Management Study. Circulation. 2009. 119. Р. 2920-2927. doi: 10.1161/CIRCULATIONAHA.108.823211.

Published

2019-06-29

How to Cite

Harbar, M., Pidhirnyy, Y., Svitlyk, Y., Svitlyk, H., & Nadolny, K. (2019). Assessing and minimization of perioperative risk in cardiologic patient in non-cardiac surgery. EMERGENCY MEDICINE, (4.99), 8–14. https://doi.org/10.22141/2224-0586.4.99.2019.173926

Issue

Section

Scientific Review

Most read articles by the same author(s)