New Frontiers in the Evaluation of Cardiac Patients for Noncardiac Surgery

Lavi, Ron; Lavi, Shahar; Daghini, Elena; Lerman, Lilach O.

doi:10.1097/01.anes.0000287613.49204.94

Cited by 12 publications

(3 citation statements)

References 68 publications

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“…Preoperative cardiac dysfunction is an independent risk factor for adverse cardiovascular events and mortality after cardiac and non-cardiac surgery [16–20]. Likewise, several studies have reported that pretransplant cardiac dysfunction is a major predictor of adverse outcomes after LT [7, 8, 10, 21].…”

Section: Discussionmentioning

confidence: 99%

Prediction of all-cause mortality after liver transplantation using left ventricular systolic and diastolic function assessment

et al. 2019

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Although pretransplant cardiac dysfunction is considered a major predictor of poor outcomes after liver transplantation (LT), the ability of left ventricular (LV) systolic/diastolic function (LVSF/LVDF), together or individually, to predict mortality after LT is poorly characterized. We retrospectively evaluated pretransplant clinical and Doppler echocardiographic data of 839 consecutive LT recipients from 2009 to 2012 aged 18–60 years. The primary endpoint was all-cause mortality at 4 years. The overall survival rate was 91.2%. In multivariate Cox analysis, reduced LV ejection fraction (LVEF, P = 0.014) and decreased transmitral E/A ratio(P = 0.022) remained significant prognosticators. In LVSF analysis, patients with LVEF≤60% (quartile [Q]1) had higher mortality than those with LVEF>60% (hazard ratio = 1.90, 95% confidence interval = 1.15–3.15, P = 0.012). In LVDF analysis, patients with an E/A ratio<0.9(Q1) had a 2.19-fold higher risk of death (95% confidence interval = 1.11–4.32, P = 0.024) than those with an E/A ratio>1.4(Q4). In combined LVDF and LVSF analysis, patients with an E/A ratio<0.9 and LVEF≤60% had poorer survival outcomes than patients with an E/A ratio≥0.9 and LVEF>60% (79.5% versus 93.3%, P = 0.001). Patients with an early mitral inflow velocity/annular velocity (E/e’ ratio)>11.5(Q4) and LV stroke volume index (LVSVI)<33mL/m2(Q1) showed worse survival than those with an E/e’ ratio≤11.5 and LVSVI ≥33mL/m2(78.4% versus 92.2%, P = 0.003). A combination of LVSF and LVDF is a better predictor of survival than LVSF or LVDF alone.

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Section: Discussionmentioning

confidence: 99%

Prediction of all-cause mortality after liver transplantation using left ventricular systolic and diastolic function assessment

et al. 2019

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“…However, Fleischmann et al (2003) demonstrated that adverse cardiac events and their outcomes can be costly. Lavi, Lavi, Daghini, and Lerman (2007) noted a risk of 0.8% for perioperative myocardial infarction in men older than 50 years of age having general surgery; this can vary more than 20% depending on cardiovascular status, comorbidities, and type of surgical procedure performed. With the mean average of the U.S. veteran population being 64 years of age, diligence to preoperative cardiac assessment cannot be understated.…”

Section: Resultsmentioning

confidence: 99%

Improving Preoperative Cardiac Assessment Efficiency by Using the American College of Cardiology/American Heart Association Guidelines: A Quality Improvement Project

et al. 2015

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Background: Patients undergoing noncardiac surgery can experience cardiac complications, which are a major cause of morbidity and mortality in the perioperative period. The goal of this quality improvement (QI) project was to standardize the preoperative assessment process and improve patient-centered care by implementing evidence-based practice guidelines for electrocardiogram (ECG) recommendations prior to noncardiac surgery. Methods: Three steps were used to implement the American College of Cardiology/American Heart Association (ACC/AHA) recommendation for ECG to reduce variance in practice and decrease surgical cancellations. A pre-and postdesign was used to evaluate 2 outcomes: decreased surgical cancellations for lack of a current ECG and surgical loss opportunity cost. All data were retrospectively collected for 60 days during the pre-and postperiods. Results: Evidence-based, preoperative ECG recommendations were implemented in the electronic medical record (EMR). Overall, ECG guideline adherence increased from 50% to 66% (x 2 5 2.19, p 5 .139) postimplementation. Surgical cancellations because of unmet ECG requirements were reduced from 50% to 34% (x 2 5 2.19, p 5 .139) post-EMR guideline implementation. There was no statistical difference in the cost associated with loss surgical opportunity minutes between the periods (t 5 0. 79, p 5 .43, 95% CI [26.96, 16.24]). Discussion: We successfully implemented an evidence-based guideline recommending specific preoperative ECG requirements within a busy Veterans Administration hospital. This project stimulated ongoing dialogue between the disciplines with positive trends in decreased surgical cancellations.

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“…Limagerie par résonance magnétique est un mode non invasif non irradiant dimagerie. Les noyaux dhydrogène des molécules deau se comportent comme des dipôles lors de lapplication dun champ magnétique et salignent dans laxe du champ30 . Lapplication dune onde de radiofréquence crée une déflection par rapport à laxe du champ magnétique.…”

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Évaluation des dommages myocardiques en postopératoire de chirurgie vasculaire et thoracique par imagerie cardiaque par résonance magnétique

Tith

Godier

Dusseaux

et al. 2013

Annales Françaises d'Anesthésie et de Réanimation

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New Frontiers in the Evaluation of Cardiac Patients for Noncardiac Surgery

Cited by 12 publications

References 68 publications

Prediction of all-cause mortality after liver transplantation using left ventricular systolic and diastolic function assessment

Prediction of all-cause mortality after liver transplantation using left ventricular systolic and diastolic function assessment

Improving Preoperative Cardiac Assessment Efficiency by Using the American College of Cardiology/American Heart Association Guidelines: A Quality Improvement Project

Évaluation des dommages myocardiques en postopératoire de chirurgie vasculaire et thoracique par imagerie cardiaque par résonance magnétique

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