Risk of Adverse Events After Coronary Artery Bypass Graft and Subsequent Noncardiac Surgery

Abstract

Post-CABG, preoperative ejection fraction less than 45%, right ventricular systolic pressure of 40 mmHg or more, as well as emergent noncardiac surgery, were predictors of adverse outcomes after the noncardiac procedure. Longer postoperative hospital stay, dialysis, as well as ventilatory support, were predictors of adverse outcomes after CABG.

2014 ESC/ESA Guidelines on non-cardiac surgery

“…This may not be the recommendation for patients with decreased LV function as illustrated in a small cohort of 211 patients who underwent non-cardiac surgery within 1 year of CABG, in which perioperative predictors for mortality at 1 year were: LV ejection fraction (LVEF) <45% (P<0.001), elevated right ventricular systolic pressure (P ¼ 0.03), emergency operation (odds ratio 6.8), need for dialysis (P ¼ 0.02) or ventilator support (P ¼ 0.03). 148 As mentioned before, patients with a previous PCI may be at higher risk of cardiac events during or after subsequent non-cardiac surgery, particularly in cases of unplanned or urgent surgery following coronary stenting. Therefore, it is preferable to postpone elective surgery whenever possible for 12 months after DES implantation.…”

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

“…This may not be the recommendation for patients with decreased LV function, as illustrated in a small cohort of 211 patients who underwent non-cardiac surgery within one year of CABG and in whom perioperative predictors for mortality at one year were: LV ejection fraction (LVEF) ,45% (P , 0.001), elevated right ventricular systolic pressure (P ¼ 0.03), emergency operation (OR 6.8), need for dialysis (P ¼ 0.02) or ventilator support (P ¼ 0.03). 148 As mentioned above, patients who have had a previous PCI may be at higher risk of cardiac events during or after subsequent non-cardiac surgery, particularly in cases of unplanned or urgent surgery following coronary stenting. It is therefore preferable, whenever possible, to postpone elective surgery until 12 months after DES implantation.…”

Grupo de Trabajo Conjunto sobre cirugía no cardiaca: Evaluación y manejo cardiovascular de la Sociedad Europea de Cardiología (ESC) y la European Society of Anesthesiology (ESA)

“…Por lo tanto, se puede concluir que los pacientes asintomáticos sometidos a CABG en los últimos 6 años están relativamente protegidos del infarto de miocardio relacionado con la cirugía no cardiaca y no requieren sistemáticamente pruebas de estrés preoperatorias. Esta recomendación podría no ser aplicable a pacientes con la función del VI deprimida, como se hizo patente en una pequeña cohorte de 211 pacientes sometidos a cirugía no cardiaca durante el primer año tras una CABG, cuyas variables perioperatorias de predicción de mortalidad a 1 año fueron: fracción de eyección del VI (FEVI) < 45% (p < 0,001), presión sistólica ventricular derecha alta (p = 0,03), cirugía urgente (OR = 6,8) y necesidad de diálisis (p = 0,02) o apoyo respiratorio (p = 0,03) 148 .…”