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Nandy K, Gangadhara B, Reddy S, Chakravarthy M, Jawali V, Thimmaiah SG, Khan A, Nayak SP. Simultaneous surgical management of malignancy and coronary heart disease. Indian J Thorac Cardiovasc Surg 2024; 40:433-439. [PMID: 38919194 PMCID: PMC11194229 DOI: 10.1007/s12055-023-01682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 06/27/2024] Open
Abstract
Coronary heart disease and cancer are the most common causes of mortality across the globe. It has been a dilemma for the surgical team to decide which surgical procedure should be done first when a patient needs surgery for both. This is a single-center retrospective observational study. Six patients who underwent simultaneous coronary artery bypass graft (CABG) and oncological surgeries between January 2018 and July 2021 were included in the study. One patient underwent lung bilobectomy via the same sternotomy incision; one underwent surgery for breast cancer, stomach cancer, and colon cancer; and one patient each of buccal mucosa carcinoma and tongue carcinoma. The median age was 65 years (59-70). Median blood loss was 550 ml (400-800). The median intensive care unit (ICU) stay was 60 h (46-130) and hospital stay was 7.5 days (6-14). The median follow-up of the present study was 31.5 months (6-38). One patient with lung carcinoma developed recurrence after 6 months and the patient is in remission after a follow-up of 32 months. Simultaneous CABG and oncological resection can be performed effectively and safely by an experienced team of cardiothoracic surgeons, surgical oncologists, and anesthetists after good patient selection.
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Affiliation(s)
- Kunal Nandy
- Department of Surgical Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | - Bharath Gangadhara
- Department of Surgical Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | - Sreekanth Reddy
- Department of Surgical Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | - Murali Chakravarthy
- Department of Anaesthesia and Critical Care, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | - Vivek Jawali
- Department of Cardiothoracic Surgery, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | | | - Ameenuddin Khan
- Department of Surgical Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
| | - Sandeep Peraje Nayak
- Department of Surgical Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, Karnataka 560076 India
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Serrao G, Vinayak M, Nicolas J, Subramaniam V, Lai AC, Laskey D, Kini A, Seethamraju H, Scheinin S. The Evaluation and Management of Coronary Artery Disease in the Lung Transplant Patient. J Clin Med 2023; 12:7644. [PMID: 38137713 PMCID: PMC10743826 DOI: 10.3390/jcm12247644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Lung transplantation can greatly improve quality of life and extend survival in those with end-stage lung disease. In order to derive the maximal benefit from such a procedure, patients must be carefully selected and be otherwise healthy enough to survive a high-risk surgery and sometimes prolonged immunosuppressive therapy following surgery. Patients therefore must be critically assessed prior to being listed for transplantation with close attention paid towards assessment of cardiovascular health and operative risk. One of the biggest dictators of this is coronary artery disease. In this review article, we discuss the assessment and management of coronary artery disease in the potential lung transplant candidate.
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Affiliation(s)
- Gregory Serrao
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.V.); (J.N.); (V.S.); (A.C.L.); (D.L.); (A.K.); (H.S.); (S.S.)
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Lianyong J, Pengkai G, Xuefeng Z, Fangbao D, Hao L. Simultaneous Minimally Invasive Coronary Artery Bypass Grafting and Lung Resection. Thorac Cardiovasc Surg 2023. [PMID: 37774755 DOI: 10.1055/a-2184-6624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND The best surgical treatment strategy for coexisting coronary artery disease (CAD) and lung cancer (LC) remains controversial. This study analyzed the safety and efficacy of a simultaneous minimally invasive procedure for patients with CAD and LC. METHODS Patients who underwent simultaneous minimally invasive off-pump coronary artery bypass grafting and lung resection from January 2016 to December 2021 were retrospectively analyzed. The procedure was performed in the fourth intercostal space through a small left anterolateral minithoracotomy. Harvesting of the left internal mammary artery (LIMA) and sewing of the anastomoses were performed under direct vision. Lung resections were performed with or without the assistance of a thoracoscope. RESULTS Sixteen patients were included with a mean age of 67.13 ± 10.61 years. Procedural success occurred in all patients with a mean operative time of 366.88 ± 94.48 minutes. All patients received at least one coronary artery bypass LIMA graft. Pneumonectomy, lobectomy, segment resection, and wedge resection were performed in one (6.25%), eight (50%), two (12.5%), and five (31.25%) patients, respectively. There were no perioperative deaths or new myocardial infarctions. Complications included one case of postoperative bleeding, two lung infections, two cases of atelectasis, one case of pleural effusion, and one case of cardiac arrhythmia. All the patients were followed up for 1 to 57 months, cancer recurrence occurred in two patients, and one patient died. The remaining patients showed no evidence of tumor recurrence or myocardial infarction. CONCLUSION This simultaneous minimally invasive procedure is safe and effective for selected patients with CAD and LC.
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Affiliation(s)
- Jiang Lianyong
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Gao Pengkai
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Zhang Xuefeng
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
- Department of Radiology, The First Affiliated Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Ding Fangbao
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Liu Hao
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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MIG-6 Is Critical for Progesterone Responsiveness in Human Complex Atypical Hyperplasia and Early-Stage Endometrial Cancer. Int J Mol Sci 2022; 23:ijms232314596. [PMID: 36498921 PMCID: PMC9738720 DOI: 10.3390/ijms232314596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Women with complex atypical hyperplasia (CAH) or early-stage endometrioid endometrial cancer (EEC) are candidates for fertility preservation. The most common approach is progesterone (P4) therapy and deferral of hysterectomy until after completion of childbearing. However, P4 therapy response rates vary, and molecular mechanisms behind P4 resistance are poorly understood. One potential molecular cause of P4 resistance is a loss or attenuation of PGR expression. Mitogen-inducible gene 6 (MIG-6) is critical for P4 responsiveness. MIG-6 protein expression in the endometrial epithelial and stromal cells from women with CAH and EEC was significantly lower compared to women without CAH or EEC. The P4-responsive women (10/15) exhibited an increase of MIG-6 expression in epithelial and stromal cells compared to P4-resistant women (5/15). In addition, immunohistochemical analysis for PGR results showed that stromal PGR levels are significantly higher in P4-responsive women compared to P4-resistant women, whereas epithelial PGR expression was not different. A reverse correlation of MIG-6 and pAKT levels was observed in early-stage EEC patients. Studies strongly suggest that loss of MIG-6 and PGR and activation of pAKT lead to P4 resistance in CAH and EEC. These results will help to elucidate the molecular mechanism leading to P4 resistance in CAH and EEC.
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Harris AHS, Bowe T, Kamal RN, Sears ED, Hawn M, Eisenberg D, Finlay AK, Hagedorn HJ, Mudumbai S. Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration. Perioper Med (Lond) 2022; 11:33. [PMID: 36096937 PMCID: PMC9469517 DOI: 10.1186/s13741-022-00265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines discourage routine preoperative screening tests for patients undergoing low-risk procedures. This study sought to determine the frequency and costs of potentially low-value preoperative screening tests in Veterans Health Administration (VA) patients undergoing low-risk procedures. METHODS Using the VA Corporate Data Warehouse, we identified Operative Stress Score class 1 procedures ("very minor") performed without general anesthesia in VA during fiscal year 2019 and calculated the overall national and facility-level rates and costs of nine common tests received in the 30 preoperative days. Patient factors associated with receiving at least one screening test, and the number of tests received, were examined. RESULTS Eighty-six thousand three hundred twenty-seven of 178,775 low-risk procedures (49.3%) were preceded by 321,917 potentially low-value screening tests representing $11,505,170 using Medicare average costs. Complete blood count was the most common (33.2% of procedures), followed by basic metabolic profile (32.0%), urinalysis (26.3%), electrocardiography (18.9%), and pulmonary function test (12.4%). Older age, female sex, Black race, and having more comorbidities were associated with higher odds of low-value testing. Transthoracic echocardiogram occurred prior to only 4.5% of the procedures but accounted for 47.8% of the total costs ($5,499,860). In 129 VA facilities, the facility-level proportion of procedures preceded by at least one test ranged from 0 to 81.2% and facility-level costs ranged from $0 to $388,476. CONCLUSIONS Routine preoperative screening tests for very low-risk procedures are common and costly in some VA facilities. These results highlight a potential target to improve quality and value by reducing unnecessary care. Measures of low-value perioperative care could be integrated into VA's extensive quality monitoring and improvement infrastructure.
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Affiliation(s)
- Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA.
- Stanford -Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, USA.
| | - Thomas Bowe
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA
| | - Robin N Kamal
- Department of Orthopedic Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Erika D Sears
- Center for Clinical Management Research, VA Ann Arbor Health Care System, Michigan Medicine Department of Surgery, Ann Arbor, USA
| | - Mary Hawn
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA
- Stanford -Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA
- Stanford -Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA
| | - Hildi J Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Medical Center, Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, USA
| | - Seshadri Mudumbai
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, USA
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Porkhanov VA, Belash SA, Polyakov IS, Barbukhatti KO, Kononenko VB, Kovalenko AL, Sitnik SD. [Simultaneous surgery for concomitant lung cancer and diffuse coronary atherosclerosis]. Khirurgiia (Mosk) 2021:42-49. [PMID: 33710825 DOI: 10.17116/hirurgia202103142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the early outcomes of simultaneous surgeries in patients with concomitant lung cancer and coronary artery disease. MATERIAL AND METHODS We retrospectively reviewed 37 consecutive patients who underwent CABG with adjunct endarterectomy (n=21) or long segmental coronary artery reconstruction (n=25) and lung resection between 2003 and 2019. Mean age was 61.4±6.7 (range 58-71) years. Males prevailed (n=32, 86.4%). Median sternotomy was used in all patients. Myocardial revascularization was followed by on-pump lung resection. The most common procedure was lobectomy (94.6%) of the right upper lobe (83.7%). Lymph node dissection was performed in all patients. RESULTS CPB time was 162±19.3 min, aortic cross-clamping time 71±14.2 min. There was no in-hospital mortality. Incidence of perioperative myocardial infarction was 5.4%. Postoperative complications were atrial fibrillation (n=6, 16.6%), re-exploration for bleeding (n=1, 2.7%), pneumonia (n=2, 5.4%). Mean hospital-stay was 14.4 days (range 11-21). CONCLUSION Simultaneous lung resections and coronary artery reconstruction is a safe and reliable surgical method in patients with diffuse coronary atherosclerosis and lung cancer. The developed system of choice, evaluation and surgical treatment of patients with concomitant cardiopulmonary pathology is fundamental for successful treatment of these difficult patients. We need larger randomized studies for certainty.
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Affiliation(s)
- V A Porkhanov
- Research Institute - Ochapovskiy Regional Clinical Hospital No.1, Krasnodar, Russia.,Kuban State Medical University, Krasnodar, Russia
| | - S A Belash
- Research Institute - Ochapovskiy Regional Clinical Hospital No.1, Krasnodar, Russia.,Kuban State Medical University, Krasnodar, Russia
| | - I S Polyakov
- Research Institute - Ochapovskiy Regional Clinical Hospital No.1, Krasnodar, Russia
| | - K O Barbukhatti
- Research Institute - Ochapovskiy Regional Clinical Hospital No.1, Krasnodar, Russia.,Kuban State Medical University, Krasnodar, Russia
| | - V B Kononenko
- Research Institute - Ochapovskiy Regional Clinical Hospital No.1, Krasnodar, Russia
| | - A L Kovalenko
- Research Institute - Ochapovskiy Regional Clinical Hospital No.1, Krasnodar, Russia
| | - S D Sitnik
- Research Institute - Ochapovskiy Regional Clinical Hospital No.1, Krasnodar, Russia
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Renfree SP, Makovicka JL, Chung AS. Risk factors for delay in surgery for patients undergoing elective anterior cervical discectomy and fusion. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:475-482. [PMID: 32042998 PMCID: PMC6989940 DOI: 10.21037/jss.2019.10.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is well-tolerated by most patients and commonly necessitates only a short hospital admission. Surgical delay after hospital admission, however, may result in longer hospital stays, consequently increasing hospital resource utilization. The current study evaluates risk factors for surgical delay in patients undergoing elective ACDF. METHODS A retrospective analysis of ACS-NSQIP data from 2006-2015 was performed. Patients undergoing elective ACDF were selected using current procedural terminology (CPT) codes (22251, 22252, 22554). A surgical delay was defined as surgery that occurred one day or later after initial hospital admission. Differences in outcomes between the non-delayed and delayed cohorts were evaluated with univariate analysis. Multivariate logistic regression was performed to identify risk factors for surgical delay. RESULTS There were a total of 771 (2.0%) surgical delays out of 39,371 patients undergoing elective ACDF from 2006-2015. Multivariate analysis found partially dependent functional status (OR 5.88; 95% CI: 4.48-7.71; P<0.001), totally dependent functional status (OR 18.22; 95% CI: 9.60-34.59; P<0.001), ASA class 4 (OR 2.73; 95% CI: 1.70-4.38; P<0.001), bleeding disorders (OR 1.75; 95% CI: 1.08-2.85; P=0.024), male sex (OR 1.19; 95% CI: 1.03-1.38; P=0.019), and chronic steroid use (OR 1.76; 95% CI: 1.30-2.37; P<0.001) as independent predictors of delay. Univariate analysis found surgical delay was associated with a higher rate of post-operative major adverse events (4.8% vs. 1.1%; P<0.001), mortality (1.0% vs. 0.2%; P<0.001) and greater than five-fold increase in total length of stay (9.52 vs. 1.65 days; P<0.001). CONCLUSIONS Impaired pre-operative functional status, a higher comorbidity burden, and chronic steroid use are risk factors for surgical delay, increased complications, and length of stay in patients undergoing elective ACDF. This is helpful information to consider given a rising incidence of cervical fusions in the Medicare population, a wide variation in costs, and increasing popularity of bundled-payment models. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | | | - Andrew S. Chung
- Orthopedic Surgery Residency, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Maxwell D, Rhee P, Drake M, Hodge J, Ingram W, Williams R. Development of the Burn Frailty Index: A prognostication index for elderly patients sustaining burn injuries. Am J Surg 2019; 218:87-94. [DOI: 10.1016/j.amjsurg.2018.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/01/2018] [Indexed: 01/19/2023]
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Teasley HE, Jeong MP, Kim TH. A calcium-dependent phospholipase A2 (cPLA2) expression is regulated by MIG-6 during endometrial tumorigenesis. Biochem Biophys Res Commun 2019; 511:129-134. [PMID: 30773264 DOI: 10.1016/j.bbrc.2019.02.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 12/19/2022]
Abstract
The ovarian steroid hormones, estrogen (E2) and progesterone (P4), are essential regulators of uterine biology. The imbalance of these ovarian steroid hormones leads to uterine diseases such as endometrial cancer, endometriosis, and infertility. Mitogen-inducible gene 6 (MIG-6) is an adaptor protein. MIG-6 mediates P4 signaling and acts as a tumor suppressor during endometrial tumorigenesis in both humans and mice. In previous studies, we developed the conditional knockout of Mig-6 in all uterine compartments (Pgrcre/+Mig-6f/f; Mig-6KO) and endometrial epithelial cell-specific Mig-6 knockout (Sprr2fcre/+Mig-6f/f; Mig-6Ep-KO) mice. Both mouse models developed endometrial hyperplasia and E2-dependent endometrial cancer. P4 treatment significantly decreases aberrant epithelial proliferation and AKT signaling in Mig-6Ep-KO mice but not in Mig-6KO mice. In the present study, we identified a calcium-dependent phospholipase A2 (cPla2) as one of the genes down-regulated by Mig-6 in the uterus. We performed immunohistochemistry and Western Blot analysis to investigate the regulation of cPLA2 by MIG-6 as well as determine the expression patterns of cPLA2 in the uterus. While the expression of cPLA2 was stronger at the uterine epithelial cells of Mig-6KO and Mig-6Ep-KO mice compared to control mice, P4 suppressed the expression of cPLA2 in Mig-6Ep-KO mice but not in Mig-6KO mice. To determine the ovarian steroid hormone regulation of cPLA2, we examined the expression of cPLA2 in ovariectomized control, Mig-6KO, Mig-6Ep-KO, and PRKO mice treated with P4 or E2. After P4 treatment, cPLA2 expression was remarkably reduced in Mig-6Ep-KO mice but not in Mig-6KO mice. However, the expression of cPLA2 was not changed in PRKO mice. Our results identified cPLA2 as a novel target of MIG-6 in the murine uterus and identified its important role during endometrial tumorigenesis.
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Affiliation(s)
- Hanna E Teasley
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, MI, 49503, USA
| | - Munseok Paul Jeong
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, MI, 49503, USA
| | - Tae Hoon Kim
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, MI, 49503, USA.
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Combined surgical treatment of esophageal cancer and coronary heart diseases in elderly patients. World J Surg Oncol 2018; 16:213. [PMID: 30355357 PMCID: PMC6201527 DOI: 10.1186/s12957-018-1512-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The co-incidence of esophageal cancer and coronary heart disease (CHD) is increasing in elderly patients. This study was carried out to analyze the efficiency and safety of simultaneous esophagectomy and cardiac surgery in a selected group of elderly patients. METHODS Prospective database for coexistency of severe CHD and esophageal or esophageal-gastric junction cancer was firstly reviewed. Twenty-two patients undergoing combined surgical interventions, including first beating-heart coronary artery bypass grafting (off-pump CABG) and then esophagectomy, were involved as group A. Then, 44 patients undergoing isolated esophagectomy were selected as group B using the propensity score matching method. Data including clinic pathological characteristics and postoperative outcomes were investigated. Kaplan-Meier analysis was used. RESULTS The surgical procedure was performed through left lateral thoracotomy in all patients, except one patient in group A who received median sternotomy and left lateral thoracotomy. The operation time and blood loss were both more in group A, as a result of two operations performed at one session. Patients in both groups were followed up from 1.3 to 78.3 months. No significant between-group was found in overall survival or relapse-free survival. CONCLUSION The risk of simultaneous esophagectomy and cardiac surgery is not high. Despite certain differences in clinical indicators between groups, the safety of simultaneous procedures in group A is evident. TRIAL REGISTRATION ChiCTR 1800014498 . Registered 17 January 2018.
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Li Z, Liu B, Ge W, Zhang W, Gu C, Liu J, Ke X, Zhang Y. Effect of simultaneous surgical treatment of severe coronary artery disease and lung cancer. J Int Med Res 2018; 47:591-599. [PMID: 30318969 PMCID: PMC6381511 DOI: 10.1177/0300060518805297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The co-incidence of lung cancer and coronary artery disease (CAD) is increasing in patients of advanced age. This study was performed to demonstrate the efficiency and safety of simultaneous coronary artery bypass grafting and lung cancer surgery in a selected group of older patients. Methods Twenty patients with severe CAD and coexisting lung cancer underwent simultaneous surgical interventions (Group A), and 20 patients with lung cancer underwent an isolated lung cancer operation (Group B). In Group A, the combined operations were carried out through 2 incisions in 3 patients, a single incision in 14 patients, and median sternotomy for heart surgery and thoracoscopic lobectomy for lung cancer in 3 patients. The single-incision approach was used in all patients in Group B. Results The operation time was longer and the blood loss volume was larger in Group A than B. No significant between-group differences were found in the 5-year relapse-free survival rate or 5-year survival rate. Conclusions The simultaneous performance of lung cancer surgery and cardiac surgery was effective and evidently safe in Group A. This treatment approach enabled earlier lung cancer resection and avoidance of the eventual complications associated with further surgical procedures.
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Affiliation(s)
- Zhi Li
- 1 Department of Cardiovascular Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University
| | - Ban Liu
- 2 Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine
| | - Wen Ge
- 3 Department of Cardiothoracic Surgery, Shuguang Hospital, affiliated to Shanghai University of TCM
| | - Wei Zhang
- 2 Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine
| | - Chang Gu
- 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Jingjing Liu
- 5 Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine
| | - Xianting Ke
- 5 Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine
| | - Yangyang Zhang
- 5 Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine.,6 Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
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Yoo JY, Kang HB, Broaddus RR, Risinger JI, Choi KC, Kim TH. MIG-6 suppresses endometrial epithelial cell proliferation by inhibiting phospho-AKT. BMC Cancer 2018; 18:605. [PMID: 29843645 PMCID: PMC5975686 DOI: 10.1186/s12885-018-4502-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/11/2018] [Indexed: 12/15/2022] Open
Abstract
Background Aberrant hyperactivation of epithelial proliferation, AKT signaling, and association with unopposed estrogen (E2) exposure is the most common endometrial cancer dysfunction. In the normal uterus, progesterone (P4) inhibits proliferation by coordinating stromal-epithelial cross-talk, which we previously showed is mediated by the function of Mitogen-inducible gene 6 (Mig-6). Despite their attractive characteristics, non-surgical conservative therapies based on progesterone alone have not been universally successful. One barrier to this success has been the lack of understanding of the P4 effect on endometrial cells. Method To further understand the role of Mig-6 and P4 in controlling uterine proliferation, we developed a Sprr2f-cre driven mouse model where Mig-6 is specifically ablated only in the epithelial cells of the uterus (Sprr2fcre+Mig-6f/f). We examined P4 effect and regulation of AKT signaling in the endometrium of mutant mice. Results Sprr2fcre+Mig-6f/f mice developed endometrial hyperplasia. P4 treatment abated the development of endometrial hyperplasia and restored morphological and histological characteristics of the uterus. P4 treatment reduced cell proliferation which was accompanied by decreased AKT signaling and the restoration of stromal PGR and ESR1 expression. Furthermore, our in vitro studies revealed an inhibitory effect of MIG-6 on AKT phosphorylation as well as MIG-6 and AKT protein interactions. Conclusions These data suggest that endometrial epithelial cell proliferation is regulated by P4 mediated Mig-6 inhibition of AKT phosphorylation, uncovering new mechanisms of P4 action. This information may help guide more effective non-surgical interventions in the future. Electronic supplementary material The online version of this article (10.1186/s12885-018-4502-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jung-Yoon Yoo
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA.,Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Hee-Bum Kang
- Department of Biomedical Sciences, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Russell R Broaddus
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, TX 77030, USA
| | - John I Risinger
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Kyung-Chul Choi
- Department of Biomedical Sciences, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea. .,Department of Pharmacology, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea.
| | - Tae Hoon Kim
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA.
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Kolarczyk LM, Arora H, Manning MW, Zvara DA, Isaak RS. Defining Value-Based Care in Cardiac and Vascular Anesthesiology: The Past, Present, and Future of Perioperative Cardiovascular Care. J Cardiothorac Vasc Anesth 2018; 32:512-521. [DOI: 10.1053/j.jvca.2017.09.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Indexed: 12/22/2022]
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14
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KАBАKOV DG, BАZАROV DV, VYZHIGINА MА, АKSELROD BА, MOROZOVА АА, KАVOCHKIN АА, BELOV YUV. RISK FACTORS OF SIMULTANEOUS SURGERY FOR CONCURRENT LUNG CANCER AND CARDIAC VASCULAR DISORDERS. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2018. [DOI: 10.21292/2078-5658-2018-15-5-87-94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Liu B, Gu C, Wang Y, Wang X, Ge W, Shan L, Wei Y, Xu X, Zhang Y. Feasibility and efficacy of simultaneous off-pump coronary artery bypass grafting and esophagectomy in elderly patients. Oncotarget 2017; 8:46498-46505. [PMID: 28148891 PMCID: PMC5542285 DOI: 10.18632/oncotarget.14824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/17/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION To analyze the outcomes of off-pump coronary artery bypass grafting (OPCABG) and esophagectomy simultaneously for patients with coronary artery disease (CAD) and coexisting esophageal cancer. METHODS Twenty-two patients with CAD and coexisting esophageal cancer underwent combined surgical interventions were subjected to the study. OPCABG was performed first, followed by esophagectomy. All the corresponding data including clinicopathological characteristics and postoperative outcomes were all investigated. RESULTS All the combined procedures were performed successfully. The average number of grafts was 2.36. Tumors were located at the middle third of the esophagus in 5 patients, at the lower third of the esophagus in 8 patients, at the esophageal gastric junction (EGJ) in 9 patients, respectively. The operations were carried out through a left lateral thoracotomy approach in 21 patients while a median sternotomy and left lateral thoracotomy approach was used in 1 patient for his condition rapidly worsened. Postoperatively, pneumonia occurred in 4 patients (18.2%). During the follow-up, three patients died of cancer metastasis /recurrence (6, 18, 37 months) and one died of pneumonia (1 month). The cumulative 5 years survival rate is 52.9%. CONCLUSIONS The combined procedure of OPCABG and esophagectomy is a safe and effective treatment option for patients with severe CAD and esophageal cancer.
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Affiliation(s)
- Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuliang Wang
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaowei Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Wen Ge
- Department of Cardiovascular Surgery, Shuguang Hospital, Affiliated to Shanghai University of TCM, Shanghai, China
| | - Lingtong Shan
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Yujian Wei
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Xiaohan Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China
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Feng CX, Li L. Modeling Zero Inflation and Overdispersion in the Length of Hospital Stay for Patients with Ischaemic Heart Disease. ADVANCED STATISTICAL METHODS IN DATA SCIENCE 2016. [DOI: 10.1007/978-981-10-2594-5_3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
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Cardiovascular pre-anesthesia evaluation in oncological surgery☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1097/01819236-201644010-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cardiovascular pre-anesthesia evaluation in oncological surgery. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rcae.2015.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Cardiopulmonary exercise testing versus spirometry as predictors of cardiopulmonary complications after colorectal surgery. Eur Surg 2015. [DOI: 10.1007/s10353-015-0359-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Gillies MA, Shah ASV, Mullenheim J, Tricklebank S, Owen T, Antonelli J, Strachan F, Mills NL, Pearse RM. Perioperative myocardial injury in patients receiving cardiac output-guided haemodynamic therapy: a substudy of the OPTIMISE Trial. Br J Anaesth 2015; 115:227-33. [PMID: 26001837 DOI: 10.1093/bja/aev137] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Evidence suggests that cardiac output-guided haemodynamic therapy algorithms improve outcomes after high-risk surgery, but there is some concern that this could promote acute myocardial injury. We evaluated the incidence of myocardial injury in a perioperative goal-directed therapy trial. METHODS Patients undergoing major gastrointestinal surgery (n=723) were randomly assigned to cardiac output-guided haemodynamic therapy (intervention group) or usual care as part of the OPTIMISE trial. At four participating sites, 288 patients were enrolled in a biomarker substudy. Serum high-sensitivity cardiac troponin I (TnI) concentration and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration were measured before and at 24 and 72 h after surgery. RESULTS Median preoperative TnI and NT-ProBNP concentrations were 4.3 ng litre(-1) and 144 pg ml(-1), respectively. After surgery, 67 (46%) patients in the intervention group and 68 (48%) patients receiving usual care had TnI concentrations above the 99th centile upper reference limit (P=0.82). Peak serum TnI concentration was similar in the intervention and usual care groups (median [interquartile range]: 10.0 [5.3-21.5] vs 7.8 [5.0-21.8] ng litre(-1); P=0.85), and no differences were observed in serum TnI concentrations over 72 h (repeated-measures anova, P=0.51). Likewise, there were no differences in peak NT-proBNP concentration between intervention and usual care groups (645 [362-1169] vs 659 [381-1028] pg ml(-1); P=0.86) or in serial NT-proBNP concentrations over 72 h (P=0.20). CONCLUSIONS Myocardial injury is common among patients undergoing major gastrointestinal surgery. In this study, the frequency was not affected by cardiac output-guided fluid and low-dose inotropic therapy.
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Affiliation(s)
- M A Gillies
- Department of Critical Care, University of Edinburgh, Edinburgh, UK
| | - A S V Shah
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - J Mullenheim
- The James Cook University Hospital, Middlesbrough, UK
| | - S Tricklebank
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Owen
- Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - J Antonelli
- Department of Critical Care, University of Edinburgh, Edinburgh, UK
| | - F Strachan
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - N L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Tabatabaee RM, Rasouli MR, Rezapoor M, Maltenfort MG, Ong AC, Parvizi J. Coronary revascularization and adverse events in joint arthroplasty. J Surg Res 2015; 198:135-42. [PMID: 26044875 DOI: 10.1016/j.jss.2015.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 04/24/2015] [Accepted: 05/07/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a paucity of literature about outcome of total joint arthroplasty in patients with the history of angioplasty and/or stent or coronary artery bypass graft (CABG). The present study aimed to evaluate perioperative complications and mortality in these patients. METHODS We used the Nationwide Inpatient Sample data from 2002-2011. Using the Ninth Revision of the International Classification of Disease, Clinical Modification codes for disorders and procedures, we identified patients with a history of coronary revascularization (angioplasty and/or stent or CABG) and compared the inhospital adverse events in these patients with patients without a history of coronary revascularization. RESULTS Cardiac complications occurred in 1.06% patients with a history of CABG; 0.95% of patients with a coronary angioplasty and/or stent and 0.82% of the control patients. In the multivariate analysis, neither the history of CABG (P = 0.07) nor the history of angioplasty and/or stenting (P = 0.86) was associated with a higher risk of cardiac complications. However, myocardial infarction occurred in a significantly higher proportion of patients with the history of CABG (0.66%, odds ratio, 1.24, P = 0.001) and coronary angioplasty and/or stenting (0.67%, odds ratio, 1.96, P < 0.001) compared with that in the controls (0.27%). History of coronary revascularization did not increase the risk of respiratory, renal, and wound complications, surgical site infection, and mortality. CONCLUSIONS Based on the findings of this study, it appears that there is no increased risk of inhospital mortality and complications (except for myocardial infarction) in patients with a history of coronary artery revascularization undergoing total joint arthroplasty. We also found perioperative cardiac arrhythmia, particularly atrial fibrillation, to be an independent predictor of inhospital adverse events.
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Affiliation(s)
| | - Mohammad R Rasouli
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Maryam Rezapoor
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mitchell G Maltenfort
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alvin C Ong
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Thanavaro JL. Cardiac risk assessment: decreasing postoperative complications. AORN J 2015; 101:201-12. [PMID: 25645037 DOI: 10.1016/j.aorn.2014.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/02/2014] [Accepted: 03/16/2014] [Indexed: 11/26/2022]
Abstract
Preoperative cardiac assessment helps identify patients undergoing noncardiac surgery who are at risk for significant postoperative cardiac complications and those who may benefit from additional preoperative evaluation and perioperative care. Advanced practice nurses can identify surgery- and patient-related risks by conducting a thorough health history and physical examination. Multiple risk indices and evidence-based guidelines are available to inform health care providers regarding patient evaluation and strategies to reduce postoperative cardiac risk. In general, preoperative tests are recommended only if the findings will influence medical therapy or perioperative monitoring or will require postponement of surgery until a cardiac condition can be corrected or stabilized. Medication management is a crucial component of the preoperative assessment; providers may need to initiate the use of beta-blockers and make decisions regarding continuing or withholding antiplatelet and anticoagulant therapy. Preoperative cardiac risk stratification, medication reconciliation, and device management are essential for providing safe care for patients.
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Singh N, Trikha S. The Role of Routine ECG Testing in Preoperative Evaluation Prior to Non Cardiac Surgery. HEART INDIA 2015. [DOI: 10.4103/2321-449x.157276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Paravertebral Block: Sole Anesthetic Technique for Lumbar Discectomy in a Patient With Limited Cardiac Reserve. J Neurosurg Anesthesiol 2014; 27:266-7. [PMID: 25222645 DOI: 10.1097/ana.0000000000000127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Lemasle L, Gayat E. Nouveautés dans la prise en charge cardiovasculaire en période périopératoire. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sabol F, Toporcer T, Kolesár A, Belák J, Luczy J. Surgical management of a patient with combined heart pathologies and lung cancer. A simultaneous coronary artery bypass surgery, aortic valve replacement, tricuspid valve repair and pulmonary resection. COR ET VASA 2014. [DOI: 10.1016/j.crvasa.2013.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Subramanayam K, Babu B, Bhat R, Reddy S. Elective use of intra-aortic balloon pumping during Whipple's procedure in a patient with ischaemic heart disease. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2013. [DOI: 10.1080/22201173.2013.10872897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - B Babu
- Department of Cardiothoracic Surgery
| | - R Bhat
- Department of Surgical Gastroenterology
| | - S Reddy
- Department of Cardiothoracic Surgery Apollo Hospitals, Bangalore, India
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Abstract
Surgical management of patients with combined coronary artery disease and malignancy remains a challenge. In this review the time of surgical intervention, whether to treat the malignancy or the coronary artery disease first, and which bypass technique should be used during myocardial revascularization are reviewed to determine the most optimal strategy to manage patients who require coronary surgical revascularization and present with an underlying malignancy.
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Affiliation(s)
- Ahmad K Darwazah
- Department of Cardiac Surgery, Makassed Hospital, Jerusalem, Israel.
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31
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WYLIE SJ, WONG GTC, CHAN YC, IRWIN MG. Endovascular aneurysm repair: a perioperative perspective. Acta Anaesthesiol Scand 2012; 56:941-9. [PMID: 22621365 DOI: 10.1111/j.1399-6576.2012.02681.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2012] [Indexed: 11/28/2022]
Abstract
Endovascular aneurysm repair (EVAR), has surpassed open repair as the technique of choice in many centres in response to several large studies which showed significantly improved 30-day mortality. While several multicentre EVAR trials looked at surgical outcomes, very few have specifically investigated the effect of anaesthetic techniques or perioperative care of these patients. The purpose of this review to is to present some of the current evidence for the different aspects of perioperative management of patients undergoing EVAR. This includes surgical considerations, pre-operative assessment, and choice of anaesthetic technique as well as pharmacological protective strategies.
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Affiliation(s)
- S. J. WYLIE
- Barts and the Royal London NHS Trust; London
| | - G. T. C. WONG
- Department of Anaesthesiology; University of Hong Kong; Hong Kong
| | - Y. C. CHAN
- Department of Surgery; University of Hong Kong; Hong Kong
| | - M. G. IRWIN
- Department of Anaesthesiology; University of Hong Kong; Hong Kong
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32
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Thanavaro JL, Fonner BJ. Preoperative Cardiac Risk Assessment and Medical Management for Noncardiac Surgery. J Nurse Pract 2012. [DOI: 10.1016/j.nurpra.2012.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Sabaté S, Mases A, Guilera N, Canet J, Castillo J, Orrego C, Sabaté A, Fita G, Parramón F, Paniagua P, Rodríguez A, Sabaté M. Incidence and predictors of major perioperative adverse cardiac and cerebrovascular events in non-cardiac surgery. Br J Anaesth 2011; 107:879-90. [DOI: 10.1093/bja/aer268] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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35
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Flynn B, Vernick W, Ellis J. β-Blockade in the perioperative management of the patient with cardiac disease undergoing non-cardiac surgery. Br J Anaesth 2011; 107 Suppl 1:i3-15. [DOI: 10.1093/bja/aer380] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Abstract
SUMMARY It is generally believed that plaque rupture and myocardial oxygen supply-demand imbalance contribute approximately equally to the burden of peri-operative myocardial infarction. This review critically analyses data of post-mortem, pre-operative coronary angiography, troponin surveillance, other pre-operative non-invasive investigations, and peri-operative haemodynamic predictors of myocardial ischaemia and/or myocardial infarction. The current evidence suggests that myocardial oxygen supply-demand imbalance predominates in the early postoperative period. It is likely that flow stagnation and thrombus formation is an important pathway in the development of a peri-operative myocardial infarction, in addition to the more commonly recognised role of peri-operative tachycardia. Research and therapeutic interventions should be focused on the prediction and therapy of flow stagnation and thrombus formation. Plaque rupture appears to be a more random event, distributed over the entire peri-operative admission.
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Affiliation(s)
- B M Biccard
- Department of Anaesthetics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, South Africa.
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37
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Odedra D, Gamlin F. Postoperative care and analgesia in vascular surgery. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2010. [DOI: 10.1016/j.mpaic.2010.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shizukuda Y, Plummer SL, Harrelson A. Customized exercise echocardiography: beyond detection of coronary artery disease. Echocardiography 2010; 27:186-94. [PMID: 20380677 DOI: 10.1111/j.1540-8175.2009.01086.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Exercise echocardiography has been established as a reliable diagnostic tool for assessment of myocardial ischemia. However, more recent advances in its technique have expanded its routine clinical use to include quantification of exercise-induced diastolic dysfunction, exercise-induced pulmonary hypertension, and dynamic assessment of mitral and aortic valve function. The indications for exercise echocardiography have increased to include cardiac symptoms such as exertional dyspnea, fatigue, and limited exercise capacity. In light of its expanded capability for evaluating cardiovascular function, we believe that exercise echocardiography should be utilized in a new paradigm of personalized cardiology, in which we regularly investigate individual patient symptoms for endpoints beyond critical myocardial ischemia, for example, exercise-induced pulmonary hypertension. We refer to this refocused use of exercise echocardiography as "customized exercise echocardiography." In this review article, we present current scientific evidence to support our proposed role and discuss the logistical requirements for proper test performance of customized exercise echocardiography.
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Affiliation(s)
- Yukitaka Shizukuda
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio 45267, USA.
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Reppel M, Weil J. [Limitation of operability. What does the internist need to know?]. Internist (Berl) 2010; 51:442-50. [PMID: 20232031 DOI: 10.1007/s00108-009-2451-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The number of elderly people that are critically ill and are send for surgery is rising rapidly. As co-morbidities such as heart disease have huge impact on the perioperative risk, identification of specific risk factors should guide the pre- and perioperative management. Several risk scores and the guidelines published by the European Society of Cardiology recently are currently available and are reviewed in the current manuscript. Evaluation of the medical history of the individual patient and functional tests are the basis for further decisions. Patients that are suffering from co-morbidities or reduced physical fitness are identified as risk patients. Patients without risk factors can be sent for surgery without additional evaluation. In moderate risk patients medication should be optimized prior to surgery. Except emergency surgery cases critical illness should be identified and treated before surgery is initiated. Depending on the number of potential risk factors non-invasive cardiac stress tests are recommended. Depending on the results also coronary angiography/-angioplasty should be performed. Acute coronary syndromes or unstable angina should preferentially be treated prior to surgery.
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Affiliation(s)
- M Reppel
- Medizinische Klinik II, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck.
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Submaximal Cardiopulmonary Exercise Testing Predicts Complications and Hospital Length of Stay in Patients Undergoing Major Elective Surgery. Ann Surg 2010; 251:535-41. [DOI: 10.1097/sla.0b013e3181cf811d] [Citation(s) in RCA: 271] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Agarwal PK, Mathew M, Virdi M. Is there an effect of perioperative blood pressure on intraoperative complications during phacoemulsification surgery under local anaesthesia? Eye (Lond) 2010; 24:1186-92. [PMID: 20139915 DOI: 10.1038/eye.2010.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The practice of deferring phacoemulsification procedure on recording raised blood pressure (BP) in the immediate perioperative period is based on the perception of increased intraoperative risk. The significance of perioperative BP recordings on the surgical complications during phacoemulsification procedure was evaluated. SETTING Hairmyres Hospitals, Lanarkshire Acute Hospitals NHS Trust. PATIENTS AND METHODS Patients were classified as hypertensive on the basis of the British Hypertension Society Guidelines. BP recordings during preoperative assessment, admission, and 1-hour postoperatively were recorded in 734 hypertensives and 740 normotensives undergoing phacoemulsification procedure. In addition, BP recordings in the holding area before giving local anaesthesia were noted in the 734 hypertensives. Patient's peri- and intraoperative complications during the procedure were noted. RESULTS The mean age was 72+/-10.5 years and 74+/-11.6 years among the hypertensives and normotensives. There was a significant increase in the number of hypertensives who developed isolated systolic hypertension in the holding area (95% confidence interval=2.82, P<0.001) where the mean BP was 171.38/78.31 mm Hg (+/-30.55/16.29). A total of 21 hypertensives and 18 normotensives developed intraoperative complications during the phacoemulsification procedure. There was no significant difference (P=0.41) in the intraoperative complications between the hypertensives and normotensives. CONCLUSION Perioperative increase in BP noted in the holding area among hypertensives did not increase the risk of surgical complications during phacoemulsification procedure when compared with normotensives. We recommend that BP should not be routinely measured in the holding area before phacoemulsification surgery under local anaesthesia.
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Affiliation(s)
- P K Agarwal
- Department of Ophthalmology, Hairmyres Hospitals, Lanarkshire Acute Hospitals NHS Trust, East Kilbride, Scotland, UK.
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Audit sur l’évaluation cardiaque préopératoire avant une chirurgie non cardiaque : utilité d’un aide-mémoire pour améliorer l’adhésion des anesthésistes aux recommandations de l’American College of Cardiology/American Heart Association (ACC/AHA). ACTA ACUST UNITED AC 2009; 28:850-4. [DOI: 10.1016/j.annfar.2009.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 08/10/2009] [Indexed: 11/19/2022]
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Sierra P, Galcerán JM, Sabaté S, Martínez-Amenós A, Castaño J, Gil A. [Hypertension and anesthesia: consensus statement of the Catalan Associations of Anesthesiology and Hypertension]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:493-502. [PMID: 19994618 DOI: 10.1016/s0034-9356(09)70440-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The prevalence of hypertension is high in the surgical population. Differing practices and the absence of consensus among physicians involved in caring for hypertensive patients has made it one of the most frequent reasons for cancelling scheduled surgery. The aim of this consensus statement is to outline a practical approach to managing the hypertensive surgical patient. Hypertension is associated with increased risk of perioperative complications, particularly those related to systemic effects and notable fluctuations in blood pressure during surgery. Preoperative assessment should center on a search for signs and symptoms of target organ damage. The anesthesiologist should seek to reduce perioperative fluctuations in arterial pressure, particularly guarding against sustained hypotension. After surgery, antihypertensive medication should be resumed as soon as possible.
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Affiliation(s)
- P Sierra
- Servicio de Anestesiología y Reanimación, Fundación Puigvert, Barcelona.
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Documento de consenso sobre hipertensión arterial y anestesia de las Sociedades Catalanas de Anestesiología e Hipertensión Arterial. HIPERTENSION Y RIESGO VASCULAR 2009. [DOI: 10.1016/j.hipert.2009.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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45
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Anaesthesia for patients with cardiac disease undergoing non-cardiac surgery. ANAESTHESIA & INTENSIVE CARE MEDICINE 2009. [DOI: 10.1016/j.mpaic.2009.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Maynard G, O'Malley CW, Kirsh SR. Perioperative care of the geriatric patient with diabetes or hyperglycemia. Clin Geriatr Med 2009; 24:649-65, viii. [PMID: 18984379 DOI: 10.1016/j.cger.2008.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The incidence of diabetes in the geriatric population is increasing and the resulting co-morbidities have led to corresponding increases in hospital admissions and surgeries. The weight of the evidence and national guidelines should dissuade us from allowing uncontrolled hyperglycemia in the geriatric perioperative population, but the glycemic target should be modified upwards based on the individual patient characteristics, and in environments that do not have an established track record of reaching more aggressive targets safely. Insulin is the most effective and flexible regimen to achieve inpatient glycemic control, whether by infusion or by subcutaneous basal bolus regimens. Strategies for safe and effective dosing and adjustment of insulin regimens, and methods to avoid hypoglycemia in the perioperative period are outlined. Finally, discharge planning should take into consideration a patient's HbA1c, preoperative glycemic control, inpatient glycemic regimen and control, financial and physical limitations, social support, co-morbid medical conditions, episodes of hypoglycemia, and overall prognosis to create an individualized safe and effective medication regimen for optimal glycemic control at home.
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Affiliation(s)
- Greg Maynard
- Division of Hospital Medicine, University of California, 200 West Arbor Drive 8485, San Diego, CA 92130, USA.
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Roberts TN. Anaesthesia. J ROY ARMY MED CORPS 2008; 154:63-8. [PMID: 19090393 DOI: 10.1136/jramc-154-01-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- T N Roberts
- Department of Anaesthesia, Derriford Hospital, Plymouth.
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Kurita T, Takata K, Morita K, Sato S. Lipophilic beta-adrenoceptor antagonist propranolol increases the hypnotic and anti-nociceptive effects of isoflurane in a swine model. Br J Anaesth 2008; 100:841-5. [PMID: 18424803 DOI: 10.1093/bja/aen089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We have previously reported that landiolol, an ultra-short-acting beta1-adrenoceptor antagonist, does not alter the anaesthetic effects of isoflurane. Here, we investigated the influence of propranolol on the electroencephalographic (EEG) effects and minimum alveolar concentration (MAC) of isoflurane. METHODS Fourteen swine [25.0 (SD 4.0) kg] were anaesthetized by isoflurane inhalation. The inhalation concentration was decreased to 0.5% and maintained for 25 min, before being returned to 2%, and maintained for a further 25 min. End-tidal isoflurane concentrations and spectral edge frequencies were recorded. Pharmacodynamic analysis was performed using a sigmoidal inhibitory maximal effect model for spectral edge frequency vs effect-site concentration. After measurement of the EEG effect, MAC was determined using the dew-claw clamp technique, in which movement in response to clamping is recorded. After completion of control measurements, a propranolol 4 mg bolus followed by an infusion (2 mg h(-1)) was started. After a 30 min stabilization period, the inhalation concentration of isoflurane was varied as in the control period and MAC was re-assessed. RESULTS Propranolol shifted the concentration-effect relationship to the left and decreased the effect-site concentration that produced 50% of the maximal effect from 1.30 (0.18) to 1.13 (0.17)%. Propranolol also decreased isoflurane MAC from 1.91 (0.35) to 1.54 (0.32)%. CONCLUSIONS Propranolol alters both the hypnotic and anti-nociceptive effects of isoflurane. In contrast to landiolol, lipophilic beta-adrenoceptor antagonists may increase the potency of inhalational anaesthetics.
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Affiliation(s)
- T Kurita
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan.
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Smith RL, Young SJ, Greer IA. The parturient with coronary heart disease. Int J Obstet Anesth 2008; 17:46-52. [PMID: 17698337 DOI: 10.1016/j.ijoa.2007.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 04/01/2007] [Indexed: 11/30/2022]
Abstract
Cardiac disease is one of the leading indirect causes of maternal mortality in the UK, exceeding numbers of direct deaths from thromboembolism and hypertension combined. Over one year in our unit we managed six women with coronary heart disease. In this series five women had stable coronary heart disease. Three delivered electively by caesarean section under combined spinal-epidural anaesthesia, a further two women had spontaneous vaginal deliveries, one planned under epidural analgesia, the second unplanned after a rapid labour. The sixth woman had unstable angina requiring percutaneous coronary intervention in the 28th week of pregnancy and went on to deliver by caesarean section under general anaesthesia. Regional anaesthesia was avoided in this case because of antiplatelet and anticoagulant medication. There is a lack of level-one evidence to direct the management of these women. Clinical decisions were directed by guidelines for the perioperative management of patients with cardiac disease in non-cardiac surgery and the management of all cardiac disease in the obstetric population. A multi-disciplinary approach was taken, with a collaborative plan made for each pregnancy and delivery. A thorough clinical history and examination together with transthoracic echocardiography allows risk stratification of women with coronary heart disease at risk of peripartum cardiac events. Further investigation specific to each woman's management can then be undertaken.
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Affiliation(s)
- R L Smith
- Department of Anaesthesia, Princess Royal Maternity Hospital, Glasgow UK
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