Perioperative Acute Myocardial Infarction Research Articles

INITIAL EXPERIENCE IN TOTAL ENDOSCOPIC MITRAL VALVE SURGERY WITH THREE–DIMENSIONAL VIDEO–ASSISTED TECHNOLOGY

Abstract Background Minimally invasive approach is nowadays the gold standard for mitral valve disease treatment. New technological tools are the key to improve surgical results and to reduce the biological invasiveness. We report our initial experience in total endoscopic mitral valve surgery using three–dimensional video–assisted technology (EinsteinVision® 3.0, B. Braun, Aesculap AG, Tuttlingen, Germany). Methods From July 2023 to December 2023, 29 patients underwent total endoscopic mitral valve surgery with three–dimensional video–assisted technology and discharged. Results Median (Q1–Q3) age of our population was 60 years (47–67) and 65.5% were males. Median (Q1–Q3) logistic Euroscore was 2.09 (1.5–4.4) and median (Q1–Q3) EuroSCORE II was 0.84 (0.6–1.2). The majority of patients were in NYHA class II and the 48.3% presented with pulmonary hypertension (PAPs > 30 mmHg). Median PAPs resulted 34.5 mmHg. One patient (3.4%) suffered from mitral valve endocarditis. No conversion to full sternotomy was necessary. In six patients with left coronary dominance (20.6%) we used indocyanine green fluorescence to conduct a real–time analysis of the course of the circumflex artery during surgery. No perioperative acute myocardial infarction was observed. No 30–day mortality was reported. One patient (3.4%) suffered from renal failure requiring dialysis, respiratory failure with tracheostomy and pneumonia. Post–operative atrial fibrillation was observed in 7 patients (24.1%) and 1 patient (3.4%) required Pace–maker implantation due to third degree AV block. No re–thoracotomy for bleeding was observed and 24.1% of patients required transfusions with packed blood cells. Non stroke were detected. Median (Q1–Q3) ventilation time was 5 hours (4–7). Median (Q1–Q3) intensive care unit postoperative length of stay were 2 (2–2) days and 7 (7–8) days respectively. Conclusions In our experience, total endoscopic mitral valve surgery with three–dimensional video–assisted technology is safe and feasible with good postoperative outcomes. Moreover, the possibility to use indocyanine green fluorescence to detect the course of the circumflex artery significantly assist surgeons in localizing and avoiding it, thus reducing the risk of perioperative myocardial infarction.

Emergent Coronary Thrombectomy for Acute Myocardial Infarction Immediately Following Craniotomy with Tumor Resection.

The management of perioperative acute myocardial infarction (AMI) following oncologic neurosurgery requires balancing competing risks of myocardial ischemia and postoperative bleeding. There are limited human data to establish the safest timing of antiplatelet or anticoagulation therapy following neurosurgical procedures. For patients with malignancy experiencing AMI in the acute postoperative period, staged percutaneous coronary intervention (PCI) with upfront coronary aspiration thrombectomy followed by delayed completion PCI may offer an opportunity for myocardial salvage while minimizing postoperative bleeding risks. CYP2C19 genotyping and platelet aggregation studies can help confirm adequate platelet inhibition once antiplatelet therapy is resumed.

Serum inflammatory factors such as MMP-9 are associated with post-percutaneous transluminal angioplastyacute myocardial infarction in coronary heart disease patients complicated by lower extremity arteriosclerosis obliterans.

This clinical study mainly analyzed the correlation of changes in serum inflammatory factors (IFs), such as matrix metalloproteinase (MMP)-9, hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-6 with post-percutaneous transluminal angioplasty (PTA)acute myocardial infarction (AMI) in coronary heart disease (CHD)patients complicated by lower extremity arteriosclerosis obliterans (ASO). This retrospective study selected sixty ASO+CHD patients (ASO group) who underwent lower limb angioplasty between January 2014 and June 2016, as well as 50 concurrent healthy controls (HCs, HC group). According to the occurrence of AMI after PTA, cases were further subdivided into AMI (n = 18) and non-AMI (n = 42) groups. For all participants, IFs (MMP-9, hs-CRP, TNF-α, and IL-6) were detected on an empty stomach. The correlations of these IFs with the post-PTAAMI risk of ASO + CHD patients were analyzed using Pearson correlation coefficients, and their predictive value for AMI was visualized by receiver operating characteristic (ROC)curves. Finally, the prognostic factors of perioperative AMI in ASO+CHD patients were identified by multivariate analysis using the Cox model. MMP-9, hs-CRP, TNF-α and IL-6 presented statistically higher levels in the AMI group than in non-AMI and HC groups and were positively correlated with AMI. ROC analysis data showed that MMP-9, hs-CRP, TNF-α and IL-6 had better diagnostic performance, sensitivity and specificity for post-PTAAMI in patients with ASO+CHD. According to Cox multivariate analysis, high levels of MMP-9, hs-CRP and IL-6 increased the risk of perioperative AMI in ASO+CHD patients after PTA. This study shows a significant correlation between the changes of serum IFs (MMP-9, hs-CRP, IL-6, and TNF-α) and post-PTA AMI in ASO patients complicated by CHD. Patients with upregulated post-PTA levels of the above Ifs in serum are at an elevated risk of developing AMI, and active and effective control will help to prevent AMI.

The optimal QTc selection in patients of acute myocardial infarction with poor perioperative prognosis

BackgroundThe predictive utility of QTc values, calculated through various correction formulas for the incidence of postoperative major adverse cardiovascular and cerebrovascular events (MACCE) in patients experiencing acute myocardial infarction (AMI), warrants further exploration. This study endeavors to ascertain the predictive accuracy of disparate QTc values for MACCE occurrences in patients with perioperative AMI.MethodsA retrospective cohort of three hundred fourteen AMI patients, comprising 81 instances of in-hospital MACCE and 233 controls, was assembled, with comprehensive collection of baseline demographic and clinical data. QTc values were derived employing the correction formulas of Bazett, Fridericia, Hodges, Ashman, Framingham, Schlamowitz, Dmitrienko, Rautaharju, and Sarma. Analytical methods encompassed comparative statistics, Spearman correlation analysis, binary logistic regression models, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).ResultsQTc values were significantly elevated in the MACCE cohort compared to controls (P < 0.05). Spearman’s correlation analysis between heart rate and QTc revealed a modest positive correlation for the Sarma formula (QTcBaz) (ρ = 0.46, P < 0.001). Within the multifactorial binary logistic regression, each QTc variant emerged as an independent risk factor for MACCE, with the Sarma formula-derived QTc (QTcSar) presenting the highest hazard ratio (OR = 1.025). ROC curve analysis identified QTcSar with a threshold of 446 ms as yielding the superior predictive capacity (AUC = 0.734), demonstrating a sensitivity of 60.5% and a specificity of 82.8%. DCA indicated positive net benefits for QTcSar at high-risk thresholds ranging from 0 to 0.66 and 0.71–0.96, with QTcBaz, prevalent in clinical settings, showing positive net benefits at thresholds extending to 0-0.99.ConclusionFor perioperative AMI patients, QTcSar proves more advantageous in monitoring QTc intervals compared to alternative QT correction formulas, offering enhanced predictive prowess for subsequent MACCE incidents.

Postoperative constrictive pericarditis caused rupture of lymphatic collaterals: a rare etiology of chylothorax

BackgroundChylothorax after cardiovascular surgery is primarily caused by direct injury to the thoracic duct or its branches, and occurs in early postoperative period. In the present case, we describe a rare case of chylothorax manifesting three months after surgery secondary to constrictive pericarditis.Case presentationA 71-year-old man underwent mitral valve replacement, tricuspid valve annuloplasty, and the maze procedure. He developed acute perioperative myocardial infarction on postoperative day one due to plaque rupture in the left anterior descending artery and underwent percutaneous coronary intervention. Although the patient was discharged on postoperative day 36, he required readmission on postoperative day 83 because of right side chylothorax associated with constrictive pericarditis. Lymphangiography revealed thoracic duct interruption and development of lymphatic collateral vessels via the right hilum. Single-photon emission computed tomography revealed abnormal tracer accumulation in the right hilum, suggesting a lymphatic leakage site. A catheter study indicated biventricular dip and plateau patterns with a reduced cardiac index (1.6 L/min/m2) and elevated central venous pressure (18 mmHg). Conservative treatment for chylothorax, including a low-fat diet and continuous drainage with chest tube, was unsuccessful. Drainage of chyle at approximately 500 mL/day continued. On hospitalization day 50, complete pericardiectomy via median sternotomy was performed because the patient’s cardiac function deteriorated. The central venous pressure dramatically decreased, and the chylothorax gradually subsided. There was no recurrence of symptoms 1 year postoperatively.ConclusionsChylothorax associated with constrictive pericarditis subsequent to cardiac surgery is extremely rare. Although conservative management failed, the present case was successfully treated via pericardiectomy alone and did not require any additional precedures, such as thoracic duct ligation via a right thoracotomy.

Perioperative Acute Myocardial Infarction and Ischemia After Noncardiac Surgery: Pathophysiology, Prevention, and Nursing Implications.

Perioperative acute myocardial infarction (AMI) after noncardiac surgery increases the mortality rate of patients who experience it. Depending on the definition of AMI used and the patient population studied, perioperative AMI occurs in 0.01% to 10% of patients. Most instances of perioperative AMI occur within the first two days after surgery, do not present with classic myocardial infarction symptoms, and are the result of myocardial oxygen supply versus oxygen demand mismatch. Older patients; those with preexisting cardiovascular conditions; those undergoing thoracic, upper abdominal, or major vascular procedures; and those who experience perioperative hemodynamic instability are at particular risk. This article provides a clinically based review of the pathophysiology, perioperative risks, treatment options, outcomes, and nursing implications of perioperative AMI and ischemia. It provides evidence to assist perioperative nurses with meeting the physiologic and safety needs of their patients and highlights the evolving scientific understanding and clinical guidelines to promote current practice.

Thiamine as an outcome predictor in postoperative CABG patients

Abstract Introduction Coronary artery bypass graft surgery (CABG) is one of the most performed cardiovascular procedures worldwide. Despite good outcomes, CABG induces systemic inflammation, increases oxidative stress and increases catabolism. As thiamine act as a cofactor in glucose metabolism and glutathione synthesis, its deficiency could have a high prevalence in critically ill patients. Purpose To assess the association between plasma thiamine concentrations and clinical outcomes and 30-day mortality in patients undergoing non-emergency CABG. Methods Prospective and observational study that included consecutive patients older than 18 years undergoing CABG that assigned the consent form. Plasma thiamine concentrations were determined before and 24 hours after the procedure by the high-performance liquid chromatography method. The clinical outcomes evaluated were perioperative acute myocardial infarction, heart failure, cardiogenic shock, arrhythmias, stroke and acute kidney injury. Mortality was evaluated on the 30th day after CABG. Results The study included 131 patients submitted to CABG. The mean age was 61±9.1 years, 73.3% were men, and the mean EuroScore II value was 1.78±1.3%. Before CABG, plasmatic thiamine concentration was 33±15ng/ml, and 15% of the patients had thiamine deficiency. After CABG, plasmatic thiamine concentration was 20±8ng/ml. All patients diminished plasmatic thiamine concentration after CABG. Mortality was 16% and 24% of patients presented acute kidney injury. Combined outcomes, which included the presence of acute myocardial infarction, heart failure, cardiogenic shock, arrhythmias, stroke, acute kidney injury or death, was present in 52% of the patients. Percentage of thiamine variation between before and after CABG was not associated with mortality (34±14 vs 41±10%; p=0.063); however, it was associated with acute kidney injury (40±14 vs 34±13%; p=0.027) and combined outcomes (37±13 vs 33±14%; p=0.035). Conclusion Percentage of thiamine variation from before to after CABG was associated with acute kidney injury and combined outcomes in these patients. Funding Acknowledgement Type of funding sources: None.

Immediate results of off-pump versus on-pump coronary artery bypass grafting using autoarterial conduits in situ and Y-graft configurations

Aim. To compare the immediate results of off-pump versus on-pump coronary artery bypass grafting (CABG) using autoarterial conduits.Material and Methods. From January 2018 to September 2021, 178 coronary artery bypass grafting operations using autoarterial conduits were performed in the Department No. 1 of the Federal Center for Cardiovascular Surgery (Krasnoyarsk). The operation was performed on a beating heart in 88 patients (group 1) and using cardiopulmonary bypass in 90 patients (group 2). The majority of patients were males in both groups: 76 (86.3%) and 75 (83.3%) patients (p = 0.287). The patients were comparable in age (61.6 ± 7.7 and 60.2 ± 7.5 years, p = 0.237), body mass index (30.9 ± 5.7 and 29.8 ± 5, p = 0.18), and the presence of concomitant diabetes mellitus (30 (34%) and 19 (21.1%), p = 0.052). There were significantly more patients with hemodynamically significant lesions of the brachiocephalic arteries in group 1 (27 (30.7%) versus 13 (14.4%), p = 0.009) and calcification of the ascending aorta (24 (27.3%) versus 11 (12.2%), p = 0.011). The number of hemodynamically significant affected coronary arteries did not differ between the groups: 2.6 ± 0.7 versus 2.5 ± 0.5 (p = 0.393).Results. Both internal thoracic arteries were used in situ or in the form of Y-grafts in both groups depending on the number of distal anastomoses. Hospital mortality was 2 patients (2.2%), both from group 2 (p = 0.161). The groups were comparable in the number of distal anastomoses (2.7 ± 0.7 and 2.7 ± 0.6, p = 0.532), the incidence of acute perioperative myocardial infarction (1 (1.1%) and 1 (1.1%), p = 0.987), neurological complications (1 (1.1%) and 2 (2.2%), p = 0.576), and bleeding requiring resternotomy (1 (1.1%) and 3 (3.3%), p = 0.325). Deep sternal wood infection was absent in both groups.Conclusion. Autoarterial coronary artery bypass grafting is an effective method of myocardial revascularization in both the beating heart surgery and in cardiopulmonary bypass conditions. This method should be considered an operation of choice for patients with multiple coronary artery disease. The performance of operations in the conditions of cardiopulmonary bypass does not affect the increase in the number of cardiocerebral events in the postoperative period.

Perioperative Myocardial Infarction in Free Flap for Head and Neck Reconstruction.

Acute myocardial infarction (AMI) is a postoperative complication of major surgical procedures, including free flap surgery. It is the most common cause of postoperative morbidity and mortality. Moreover, patients receiving free flap reconstruction for the head and neck have significant risk factors such as coexisting coronary artery disease (CAD). Our primary aim was to ascertain predictors of perioperative AMI to enable early detection and consequently early treatment of perioperative AMI. Our secondary aim was to determine the group of patients who would be at a high risk for perioperative AMI after free flap surgery. This retrospective study enrolled patients who underwent free flap reconstruction surgery at the Division of Plastic and Reconstructive Surgery of Taipei Veterans General Hospital between 2013-01 and 2017-12. This study included 444 patients and 481 free flap head and neck reconstruction surgeries. Fifteen (3.1%) patients were diagnosed with perioperative AMI. Statistical analysis of the variables revealed that patients with underlying CAD or cerebrovascular accident (CVA) were at a high risk of developing perioperative AMI (odds ratio: 6.89 and 11.11, respectively). The flap failure rate was also higher in patients with perioperative AMI compared with those without perioperative AMI (P = 0.015). Patients with underlying diseases, such as CAD or CVA, constituted high-risk groups for perioperative AMI.

Relation of Previous Coronary Artery Bypass Grafting and/or Percutaneous Coronary Intervention to Perioperative Cardiovascular Outcomes in Patients Who Underwent Noncardiac Surgery

Patients with ischemic heart disease frequently undergo noncardiac surgery. We examined perioperative surgical outcomes in patients with and without previous coronary revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Adults ≥45 years old who underwent noncardiac surgery between 2010 and 2014 were identified from the National Inpatient Sample. Previous CABG and PCI were identified using International Classification of Diseases, Ninth Revision codes. Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as the composite of in-hospital mortality, acute myocardial infarction, and acute ischemic stroke. Multivariable logistic regression models were used to estimate associations between previous coronary revascularization and surgical outcomes after adjustment for clinical covariates. We identified 25,091,140 hospitalizations for noncardiac surgery, of which 8.4% had a history of coronary revascularization (47% previous CABG without PCI, 45% previous PCI without CABG, and 8% previous CABG and PCI). Hospitalized patients with versus without previous coronary revascularization had a higher crude incidence (4.0% vs 2.6%, p<0.001) but lower odds of MACCE (adjusted odds ratio 0.96, 95% CI 0.94 to 0.98) driven by a lower risk of death and ischemic stroke. When analyzed by revascularization strategy, lower odds of MACCE were restricted to patients with previous CABG, driven by excess perioperative acute myocardial infarction risks after PCI. In patients with established cardiovascular disease, previous coronary revascularization was associated with lower odds of MACCE (adjusted odds ratio 0.76, 95% CI 0.75 to 0.78), regardless of revascularization strategy. In conclusion, previous coronary revascularization is associated with lower odds of MACCE after noncardiac surgery, but perioperative risks vary by mode of coronary revascularization.

Trends in early postoperative major adverse cardiovascular and cerebrovascular events associated with bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.

The population undergoing bariatric surgery (BaS) has many cardiovascular risk factors that can lead to significant perioperative cardiovascular morbidity. We aimed to examine trends in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) after BaS. Academic Hospital, United States METHODS: We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2015 to 2019. Data on demographics, co-morbidities, and type of procedure were collected. MACCE was defined as a composite variable including perioperative acute myocardial infarction (AMI), cardiac arrest requiring cardiopulmonary resuscitation, acute stroke, and all-cause mortality. We utilized the Cochrane-Armitage and Jonckheere-Terpstra tests to assess for significant trend changes throughout the years. A total of 752,722 patients were included in our analysis (LSG = 73.2%, LRYGB = 26.8%). Postoperative MACCE occurred in 1058 patients (.14%), and was more frequent in patients undergoing LRYGB (.20%). The frequency of MACCE declined from .17% to .14% (P = .053), driven by a decline in the frequency of AMI (.04% to .02%, P = .002), cardiac arrest (.05% to .04%, P = .897), and all-cause death (.11% to .08%, P = .040), but with an increase in perioperative stroke (.01% to .02%, P = .057). The overall risk of MACCE after BaS is .14% and has been declining in the last 5 years. This trend is likely multifactorial and further analysis is necessary to provide a detailed explanation.

Predictors of 30-day postoperative systemic complications in geriatric patients undergoing elective brain tumor surgery

Little evidence exists to guide the preoperative selection of elderly brain tumor patients who are fit for surgery. We aimed to evaluate the safety of brain tumor resection in geriatric patients and identify predictors of postoperative 30-day systemic complications. We conducted a retrospective cohort study of 212 consecutive patients at or above the age of 60 years who underwent elective brain tumor resection between 2007 and 2017. The primary outcome measures analyzed were perioperative systemic complications within 30 days after the operation. A total of 212 geriatric brain tumor patients were included. Fifty-two (24.5%) had a 30-day systemic complication. Among them, 29 (13.7%) had systemic infections, 13 (6.1%) had perioperative seizures, 10 (4.7%) had syndrome of inappropriate antidiuretic hormone secretion (SIADH), five (2.4%) had deep venous thrombosis (DVT), four (1.9%) had perioperative stroke, three (1.4%) had acute myocardial infarction (AMI) and three (1.4%) had central nervous system (CNS) infections. One patient (0.5%) died. Perioperative stroke was predicted by previous stroke (p = 0.040), chronic liver disease (p < 0.001) and vestibular schwannoma (p = 0.002 with reference to meningiomas). Perioperative AMI was predicted by co-existing ischemic heart disease (p = 0.031). Systemic infection was predicted by female gender (p = 0.007) and preoperative Karnofsky Performance Scale (KPS) score < 70 (p = 0.019). DVT was predicted by GBM (p = 0.014). In conclusion, brain tumor surgery can be safe in carefully-selected geriatric patients. The risk factors identified in this study would be helpful to select suitable candidates for surgery.

Perioperative Acute Myocardial Infarction in the First Deceased Kidney Transplantation Done in Bihar.

Perioperative Acute Myocardial Infarction in the First Deceased Kidney Transplantation Done in Bihar.

Morbidity and Mortality After Acute Myocardial Infarction After Elective Major Noncardiac Surgery

To develop parsimonious models of in-hospital mortality and morbidity risk after perioperative acute myocardial infarction (AMI). Retrospective data analysis. National Inpatient Sample (2008-2013), a 20% sample of all non-federal in-patient hospitalizations in the United States. Patients 45 years or older who experienced perioperative AMI during elective admission for noncardiac surgery. The study used a mixed principal components analysis and multivariate logistic regression to identify risk factors for in-hospital mortality after perioperative AMI. A model incorporating only preoperative risk factors, defined by the Revised Cardiac Risk Index (RCRI), was compared with a "full risk factor" model, incorporating a large set of preoperative AMI risk factors. The risk of post-AMI disposition to an intermediate care or skilled nursing facility, a marker of functional impairment, then was evaluated. In the present study, 15,574 cases of AMI after elective noncardiac surgery were identified (0.42%, corresponding with 78,122 cases nationally), with a 12.4% in-hospital mortality rate. The "RCRI-only" model was the best-fit model of post-AMI in-hospital mortality risk, without loss of predictive accuracy compared with the "full risk factor" model (area under the receiver operator characteristic curve 0.80, 95% confidence interval [CI] [0.77-0.82] v area under the receiver operator characteristic curve 0.81, 95% CI [0.77-0.83], respectively). Post-AMI mortality risk was the highest for perioperative complications, including sepsis (odds ratio 4.95, 95% CI [4.32-5.67]). Conversely, functional impairment was best predicted by the "full-risk factor" model and depended strongly on chronic preoperative comorbidities. The RCRI provides a simple but adequate model of preoperative risk factors for in-hospital mortality after perioperative AMI.

P0586ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING CARDIAC SURGERY: A PROSPECTIVE, OBSERVATIONAL STUDY TO ASSESS INCIDENCE, SEVERITY, RISK FACTORS AND MORTALITY IN TERTIARY CARE HOSPITAL IN INDIA

Abstract Background and Aims Acute kidney injury (AKI) occurs in up to 30% of patients undergoing cardiac surgeries and is associated with increased morbidity and mortality. There is paucity of such data in our country. Hence this study was done to assess the incidence of AKI following cardiac surgery and its associated risk factors along with outcomes, in the Indian context. The incidence and severity of AKI in patients with normal renal parameters vs those with underlying CKD was studied. We also compared incidence and severity of AKI in patients undergoing surgery off pump vs on pump. Method All patients age&amp;gt;25yrs of either gender undergoing cardiac surgeries were enrolled prospectively from July to October 2018. Patients undergoing aortic surgeries or on dialysis, renal transplants or with pre-existing AKI were excluded. Incidence and severity of AKI was defined by the AKIN criteria. NKF/DOQI definition was used to define CKD. Prevalence of risk factors such as age, sex, BMI, diabetes mellitus, hypertension, dyslipidemia, CKD, CVA, peripheral vascular disease (PVD), prior myocardial infarction (MI), peri-operative acute myocardial infarction (AMI), use of cardiopulmonary bypass (CPB) and prolonged ventilation were assessed. Results 1,040 patients were enrolled with these baseline characteristics: 83.5% were males, mean age 58.2±10.4 years, mean BMI 25.6±4.3, diabetes in 48.2%, hypertension in 57.5%,dyslipidemia in 70%,CVA in 36%,CKD in 6.3%,PVD in 0.9%,peri-operative AMI in 0.6%,use of CPB in 24%. Overall incidence of AKI was 23.3% and was 71.2% in patients with underlying CKD. AKI was more severe in patients with higher CKD stages. Stage3 AKI occurred only in patients with CKD stage 3 and 4. Overall the need for dialysis was 1.1% and it was 4.9% in AKI group. 8.5% of patients with CKD needed dialysis as compared to 4.1% without CKD.In multivariate risk factor analysis hypertension (p=0.01),peri-operative AMI (p=0.03), prolonged ventilation (p=0.01), CVA (p=0.01) and CKD (p&amp;lt;0.001) were found to be significantly associated with AKI whereas diabetes (p =0.12), PVD (p=0.13), use of CPB (p=0.4), prior AMI (p=0.07) were not significant. Mean hospital stay was prolonged in those with AKI (8.33±4.06 vs 7.16±3.01 days (p&amp;lt;0.001)). Overall the mortality was 0.67% and it was 2.9% in AKI group. All mortalities were associated with AKI. Conclusion Incidence of AKI (23.3%) and mortality (0.67%) in cardiac surgery patients at our centre in India is similar to other reported studies. We found that underlying CKD is the most significant risk factor for AKI in these patients in addition to hypertension, CVA, prolonged ventilation and pre-operative AMI. Use of CPB did not increase the incidence of AKI. AKI significantly increases mean hospital stay and is also associated with increased in-hospital mortality.

Abstract P338: Cardiovascular And Cerebrovascular Events Associated With Cancer Surgery In The United States

Background: Major adverse cardiovascular and cerebrovascular events (MACCE) are significant causes of perioperative morbidity and mortality but, the incidence and effects following cancer surgeries are unknown. The aims of this study were to evaluate national trends in MACCE after major cancer surgeries and to identify cancer types associated with cardiovascular events using a large national database. Methods: Patients who had major cancer surgeries from 2005 to 2014 were identified from the National Inpatient Sample database. Hospitalizations for surgeries for cancer of prostate, bladder, esophagus, pancreas, lung, liver, breast, colon and rectum were identified by ICD9 diagnosis and procedure codes. The main outcome was perioperative MACCE, defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, and was evaluated over time. Results: Among 2,854,810 hospitalizations for major cancer surgeries, perioperative MACCE occurred in 67,316 hospitalizations (2.4%). Mean (SE) age of patients was 65.4 (0.07) years and 54.2% were male patients. MACCE occurred most frequently in patients undergoing surgeries for lung (6.8%), pancreatic (4.5%), and colorectal (3.3%) cancers. Between 2005 and 2014, the frequency of MACCE declined from 2.7% to 2.2% ( P &lt;0.001) and was driven by a decline in the frequency of perioperative death ( P &lt;0.001) and AMI ( P = 0.002). However, no significant changes were observed for acute ischemic stroke ( P = 0.6) during the study period. Conclusion: Perioperative MACCE occurs in 1 out of every 42 hospitalizations for major cancer surgeries. Despite reductions in the rate of death and AMI among patients undergoing major cardiac surgeries, perioperative ischemic stroke remained constant over time. The lack of improvements in perioperative ischemic stroke rate is concerning and requires additional interventions. Significant efforts should be directed towards improving cardiovascular care during the perioperative period of cancer surgeries.

Coronary Endarterectomy: a Case Control Study and Evaluation of Early Patency Rate of Endarterectomized Arteries

ObjectiveTo compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE.MethodsWe reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P< 0.05.ResultsThere was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature.ConclusionIn this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.

Perioperative acute myocardial infarction in patients after non-cardiac surgery in China: Characteristics and risk factors.

To examine the characteristics and short-term outcome of perioperative myocardial infarction (PMI), a single-center retrospective study was carried out. The electronic medical records of 278,939 patients aged 45 years or older who underwent non-cardiac surgery at Renji Hospital from January 2003 to December 2015 were screened based on diagnostic codes (ICD121, ICD121.0, ICD121.1, ICD121.2, ICD121.3, ICD121.4, or ICD121.9). The incidence and characteristics of PMI and mortality risk factors were analyzed after non-cardiac surgery. PMI was reported in 45 patients, with an incidence rate of 1.61 per 10,000 and a mortality rate of 75.6% (34/45). The PMI incidence rate increased significantly with age. The PMI incidence rate was the highest for vascular surgery (5.82 per 10,000 cases). PMI occurs mainly within 48 h of surgery, with most cases showing an onset in the general wards. Logistic analysis showed that the use of nitrates is the independent protective factor for the outcomes of patients with PMI. The incidence of PMI in non-cardiac surgery is approximately 2 of 10,000 in patients aged 45 years or older, and increased significantly with age. The use of nitrates might be helpful for their survival.

Perioperative acute myocardial infarction rate in chronic renal disease patients undergoing orthopedic surgery: Is there any difference between dialyzed and nondialyzed patients?

BackgroundThe incidence of acute myocardial infarction (AMI) in healthy patients undergoing noncardiac surgery is <1%. When patients with chronic kidney disease (CKD) undergo orthopedic surgery, AMI incidence can be expected to be relatively high. However, data on a population-wide scale is lacking.ObjectiveTo investigate AMI incidence in patients with CKD (with and without dialysis) undergoing orthopedic surgery.DesignA population-based study covering the period from January 1, 1997, to December 31, 2011.SettingData from the Taiwan National Health Insurance Research Database.ParticipantsParticipants were 219,195 patients with CKD who underwent surgery between January 1, 1997, and December 31, 2011.ResultsAMI occurred in 2,708 participants (1.24%). The AMI incidence rate in the dialyzed group was 1.52%, which was higher than that in the nondialyzed group after propensity score matching. Dialysis (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.62–1.98), male (OR: 1.42; 95% CI: 1.28–1.57), diabetes mellitus (OR: 1.61; 95% CI: 1.44–1.80), hyperlipidemia (OR: 1.88; 95% CI: 1.68–2.11), old myocardial infarction (OR: 18.87; 95% CI: 16.26–1.21.90), and cerebral vascular disease (CVA) (OR: 1.29; 95% CI: 1.30–1.47) were all associated with AMI in the patients with CKD.ConclusionsThe AMI risk was higher in the patients with CKD undergoing orthopedic surgery than in the general population, and the dialyzed group had a higher risk of AMI than did the nondialyzed group.

Acute myocardial infarction associated with the induction of general anesthesia

Perioperative acute myocardial infarction (AMI) is the most common cause of postoperative morbidity and mortality. It is a rare but important and fatal complication. Recognizing this situation may be difficult due to the influence of general anesthesia. Early diagnosis and treatment can decrease the morbidity and mortality of this fatal complication. In this case we present a 56-year-old female planned nephrectomy. After induction of general anesthesia acute inferoposterior myocardial infarction occurred and coronary angiograhy showed the proximal portion of the circumflex coronary artery (Cx) was occluded by thrombus, the left anterior descending coronary artery and the right coronary artery were plaque. Percutaneous transluminal coronary angioplasty and the stenting resulted in successful dilatation of the Cx and she was discharged at the fifth day of intervention without any complication.