Cardiac protection by preoperative intervention in noncardiac surgery
1Department of Anesthesiology and Intensive Care Medicine Medical University of Graz
DOI: 10.22514/SV21.052007.3 Vol.2,Issue S1,May 2007 pp.19-22
Published: 01 May 2007
Preoperative coronary intervention is one option to optimize the cardiac risk patient scheduled for noncardiac surgery. Such an intervention, however, is only justified for high risk procedures and if the indication for preoperative intervention is independent from surgery.
Currently, PTCA with stent implantation is the most commonly used practice. Dependent of the type of stent (bare-metal stent or drug-eluting stent) dual antiplatelet therapy is mandatory for 1 – 12 months.
The surgeon, the cardiologist and the anesthesiologist have to decide in an interdisciplinary approach the perioperative management to navigate the patient between stent thrombosis and surgical bleeding.
noncardiac surgery, car-diac risk, percutaneous coronary intervention, coronary stents.
HELFRIED METZLER,S. ARCHAN. Cardiac protection by preoperative intervention in noncardiac surgery. Signa Vitae. 2007. 2(S1);19-22.
1. Eagle KA. Cardiac risk of noncardiac surgery. Influence of coronary disease and type of surgery in 3368 patients. Circulation 1997;96:1882-7.
2. Fleisher LA, Eagle KA, Shaffer T, Anderson GF. Perioperative and longterm mortality rates after major vascular surgery: The relationship to preoperative testing in the medicare population. Anesthesia Analgesia 1999;89:849-55.
3. Fleisher LA, Eagle KA. Lowering cardiac risk in noncardiac surgery. New England Journal of Medicine 2001;345:1677-82.
4. McFalls E, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thot-tapurathu L, Ellis N, Reda DJ, Henderson WG. Coronary-artery revascularization before elective major vascular surgey. New England Journal of Medicine 2004;351:2795-804.
5. Godet G, Riou B, Bertrand M, Fléron HH, Goarin JP, Montalescot G, Coriat P. Does preoperative coronary angioplasty improve periopera-tive cardiac outcome? Anesthesiology 2005;102:739-46.
6. Kaluza GL, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes on noncardiac surgery soon after coronary stenting. Journla of the American College of Cardiology 2000;35:1288-94.
7. Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, MelbyS, Berger PB. Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting. Journal of the Amercian College of Cardiology 2003;42:234-50.
8. Vicenzi MN, Meislitzer T, Heitzinger B, Halaj M, Fleisher LA, Metzler H. Coronary artery stenting and non-cardiac surgery – a prospective outcome study. British Journal of Anaesthesia 2006;96:686-93.
9. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognnoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. New England Journal of Medicine 2001;345:494-502.
10. Chu MWA, Wilson SR, Novick RJ, Stitt LW, Quantz MA. Does clopidogrel increase blood loss following coronary artery bypass surgery?Annals of Thoracic Surgery 2004;78:1536-41.
11. Ascione R, Ghosh A, Rogers CA, Cohen A, Monk C, Angelini GD. In-hospital patients exposed to clopidogrel before coronary artery bypass graft surgery: A word of caution. Annals of Thoracic Surgery 2005;79:1210-6.
12. ACC/AHA Practice Guidelines. ACC/AHA guideline update for perioperative cardiovascular elevation for noncardiac surgery – executive summary. Journal of the American College of Cardiology 2002;39:542-53.
13. ESC Guidelines for Percutaneous Coronary Interventions. The task force for percutaneous coronary interventions of the European Society of Cardiology. Guidelines for percutaneous coronary interventions. European Heart Journal 2005;26:804-47.
14. ACC/AHA/SCAI. Guideline update for percutaneous coronary intervention – summary article: a report of the American College of Cardiol-ogy/American Heart Association Task Force on practice guidelines. Journal of the American College of Cardiology 2006;47:216-35.
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