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杨 阳, 肖 锋, 王 进, 宋 波, 李 西, 张 师, 何 志, 张 寰, 尹 玲. [One-stage surgery in patients with both cardiac and non-cardiac diseases]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:327-331. [PMID: 33879906 PMCID: PMC8072429 DOI: 10.19723/j.issn.1671-167x.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the possibility and feasibility of one-stage cardiac and non-cardiac surgery. METHODS From July 1999 to August 2018, one hundred and eleven patients suffering from cardiac and non-cardiac diseases were treated by one-stage cardiac and non-cardiac operation in Department of Cardiac Surgery and Thoracic Surgery, General Surgery, Urinary Surgery, and Gynecology, Peking University First Hospital. There were 83 males (74.8%) and 28 females (25.2%), aged 41 to 84 years [mean age: (64.64±8.97) years]. The components of the cardiac disease included coronary heart disease, valvular heart disease, cardiac tumors, chronic constrictive pericarditis and congenital heart disease. The components of the non-cardiac diseases included lung benign and malignant diseases, thymoma and thymic cyst, breast cancer, chest wall giant hemangioma, digestive tract benign and malignant diseases, urinary system carcinoma and gynecological diseases. RESULTS Two patients died after operations in hospital; thus, the hospital mortality rate was 1.8%. One patient died of multiple organ failure on the 153th days after emergency coronary artery bypass grafting (CABG) combined with radical resection of bladder cancer. The other of pericardium stripping with lung cancer operation died of the multiple organ failure on the tenth day after surgery. The remaining 109 patients recovered and were discharged. There were 13 cases of complications during the days in hospital. The total operative morbidity was 11.7%: postoperative hemorrhage in 2 cases (1.8%), pulmonary infection and hypoxemia in 3 cases (2.7%), hemorrhage of upper digestive tract in 1 case (0.9%), incisional infection in 3 cases (2.7%), subphrenic abscess in 1 case (0.9%), and postoperative acute renal failure and hemofiltration in 3 case (2.7%). Of the 109 patients discharged, 108 patients were followed up. All the patients survived for 6 months, and 21 patients died due to tumor recurrence or metastasis within 1 to 5 years of follow-up, but no cardiogenic death. During the follow-up period, 1 patient developed cardiac dysfunction, 1 patient underwent percutaneous coronary intervention (PCI), 1 patient had cerebral hemorrhage due to excessive postoperative anticoagulation, and 1 patient suffered from incisional hernia. CONCLUSION One-stage surgeries in patients suffering from both cardiac and non-cardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival.
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Affiliation(s)
- 阳 杨
- 北京大学第一医院心脏外科,北京 100034Department of Cardiac Surgery, Peking University First Hospital, Beijing 100034, China
| | - 锋 肖
- 北京大学第一医院心脏外科,北京 100034Department of Cardiac Surgery, Peking University First Hospital, Beijing 100034, China
| | - 进 王
- 北京大学第一医院心脏外科,北京 100034Department of Cardiac Surgery, Peking University First Hospital, Beijing 100034, China
| | - 波 宋
- 北京大学第一医院心脏外科,北京 100034Department of Cardiac Surgery, Peking University First Hospital, Beijing 100034, China
| | - 西慧 李
- 北京大学第一医院心脏外科,北京 100034Department of Cardiac Surgery, Peking University First Hospital, Beijing 100034, China
| | - 师杰 张
- 北京大学第一医院胸外科,北京 100034Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, China
| | - 志嵩 何
- 北京大学第一医院泌尿外科,北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 寰 张
- 北京大学第一医院普通外科,北京 100034Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - 玲 尹
- 北京大学第一医院妇产科,北京 100034Department of Gynecology, Peking University First Hospital, Beijing 100034, China
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Kitamura Y, Suzuki K, Teramukai S, Sonobe M, Toyooka S, Nakagawa Y, Yokomise H, Date H. Feasibility of Pulmonary Resection for Lung Cancer in Patients With Coronary Artery Disease or Atrial Fibrillation. Ann Thorac Surg 2016; 103:432-440. [PMID: 27793400 DOI: 10.1016/j.athoracsur.2016.08.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to clarify the outcomes of lung resection for lung cancer in patients with cardiac disease, especially coronary artery disease, in a large-scale multi-institutional cohort. METHODS We retrospectively analyzed the data on 1,254 patients who underwent major lung resection for lung cancer and had been diagnosed with coronary stenosis, atrial fibrillation, or both, in 58 institutions in Japan between January 2009 and December 2011. The primary outcome was 90-day postoperative mortality or in-hospital death. RESULTS Among the 1,254 patients, 902 (71.9%) and 452 patients (36.0%) were preoperatively diagnosed with coronary stenosis and atrial fibrillation, respectively, and 951 patients (75.8%) received antiplatelet therapy. Among the patients with coronary stents (n = 532; 42.4%), 204 (16.3%) received drug-eluting stents. The 90-mortality or in-hospital death rate was 2.6% (n = 32), including stent thrombosis (n = 1), thromboembolic events without stent thrombosis (n = 2), and bleeding events (n = 2). In the multivariate analyses, blood transfusion, history of cerebrovascular disease, amount of bleeding, and history of congestive heart failure were associated with a higher independent risk of 90-day mortality or in-hospital death (odds ratio, 9.400, 3.574, 2.827, and 2.945, respectively). Preoperative discontinuation of antiplatelet therapy was not associated with an independent risk of 90-day mortality or in-hospital death on univariate analysis. CONCLUSIONS Major lung resection for lung cancer in patients with coronary artery disease is feasible. Our study suggests that discontinuation of antiplatelet therapy may not increase postoperative complications in patients with coronary artery disease.
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Affiliation(s)
- Yoshitaka Kitamura
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | | | - Hiroyasu Yokomise
- Department of General Thoracic, Breast and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
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Yang Y, Xiao F, Wang J, Song B, Li XH, Li J, He ZS, Zhang H, Yin L. Simultaneous surgery in patients with both cardiac and noncardiac diseases. Patient Prefer Adherence 2016; 10:1251-8. [PMID: 27486311 PMCID: PMC4957679 DOI: 10.2147/ppa.s100588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery. METHODS From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries. RESULTS Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG), bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%]), pulmonary infection and hypoxemia (2, 3.1%), hemorrhage of upper digestive tract (1, 1.6%), incisional infection (3, 4.7%), subphrenic abscess (1, 1.6%), and postoperative acute renal failure and hemofiltration (3, 4.7%). Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%. CONCLUSION Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival.
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Affiliation(s)
- Yang Yang
- Department of Cardiac Surgery
- Correspondence: Yang Yang, Department of Cardiac Surgery, Peking University First Hospital, No 8 Xishiku Street, Beijing 100034, People’s Republic of China, Tel +86 10 8357 2744, Email
| | | | | | - Bo Song
- Department of Cardiac Surgery
| | | | - Jian Li
- Department of Thoracic Surgery
| | | | | | - Ling Yin
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China
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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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Levin AI, Coetzee AR. Statins and perioperative myocardial infarction. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2007.10872486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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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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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Ceppa DP, Welsby IJ, Wang TY, Onaitis MW, Tong BC, Harpole DH, D'Amico TA, Berry MF. Perioperative management of patients on clopidogrel (Plavix) undergoing major lung resection. Ann Thorac Surg 2011; 92:1971-6. [PMID: 21978871 DOI: 10.1016/j.athoracsur.2011.07.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 07/12/2011] [Accepted: 07/19/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Management of patients requiring antiplatelet therapy with clopidogrel (Plavix) and major lung resection must balance the risks of bleeding and cardiovascular events. We reviewed our experience with patients treated with clopidogrel perioperatively to examine outcomes, including results of a new strategy for high-risk patients. METHODS Patients who underwent major lung resection and received perioperative clopidogrel between January 2005 and September 2010 were reviewed. Initially, clopidogrel management consisted of discontinuation approximately 5 days before surgery and resumption immediately after surgery. After July 2010, high-risk patients (drug-eluting coronary stent placement within prior year or previous coronary event after clopidogrel discontinuation) were admitted 2 to 3 days preoperatively and bridged with the intravenous glycoprotein IIb/IIIa receptor inhibitor eptifibatide (Integrilin) according to a multidisciplinary cardiology/anesthesiology/thoracic surgery protocol. Outcomes were compared with control patients (matched for preoperative risk factors and extent of pulmonary resection) who did not receive perioperative clopidogrel. RESULTS Fifty-four patients who had major lung resection between January 2005 and September 2010 and received clopidogrel perioperatively were matched with 108 control subjects. Both groups had similar mortality, postoperative length of stay, and no differences in the rates of perioperative transfusions, reoperations for bleeding, myocardial infarctions, and strokes. Seven of the 54 clopidogrel patients were admitted preoperatively for an eptifibatide bridge. Two of these patients received perioperative transfusions, but there were no deaths, reoperations, myocardial infarctions, or stroke. CONCLUSIONS Patients taking clopidogrel can safely undergo major lung resection. Treatment with an eptifibatide bridge may minimize the risk of cardiovascular events in higher risk patients.
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Affiliation(s)
- Duykhanh P Ceppa
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Newsome LT, Weller RS, Gerancher JC, Kutcher MA, Royster RL. Coronary Artery Stents: II. Perioperative Considerations and Management. Anesth Analg 2008; 107:570-90. [DOI: 10.1213/ane.0b013e3181731e95] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Godet G, Le Manach Y, Lesache F, Perbet S, Coriat P. Drug-eluting stent thrombosis in patients undergoing non-cardiac surgery: is it always a problem? Br J Anaesth 2008; 100:472-7. [DOI: 10.1093/bja/aen033] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Metzler H, Kozek-Langenecker S, Huber K. Antiplatelet therapy and coronary stents in perioperative medicine – the two sides of the coin. Best Pract Res Clin Anaesthesiol 2008; 22:81-94. [DOI: 10.1016/j.bpa.2007.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Patients in whom any kind of stent, particularly a drug-eluting stent (DES), was recently implanted are at risk for stent thrombosis when they undergo noncardiac surgery, even months or years after their implantation. The risk of DES thrombosis is likely decreased by delaying noncardiac surgery for as long as possible and continuing dual or at least single antiplatelet therapy in the perioperative period. Preoperative identification and close monitoring of patients with DES may allow prevention and prompt detection and treatment of this catastrophic complication.
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Schoenmakers MCJ, van Boven WJ, van den Bosch J, van Swieten HA. Comparison of On-Pump or Off-Pump Coronary Artery Revascularization With Lung Resection. Ann Thorac Surg 2007; 84:504-9. [PMID: 17643624 DOI: 10.1016/j.athoracsur.2007.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 03/29/2007] [Accepted: 04/02/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The simultaneous occurrence of coronary artery disease and lung cancer is rare. The best surgical treatment strategy remains controversial: performing a combined procedure with or without the use of extracorporeal circulation (ECC). The aim of this study was to compare the surgical procedure, postoperative complications, and survival of combined surgery with the use of ECC to combined surgery without ECC. METHODS Forty-three patients underwent a combined procedure between 1994 and 2005. Twenty-eight patients (25 male and 3 female; mean age, 66 years; range, 54 to 76 years) underwent coronary artery (CA) revascularization with ECC after the lung resection was carried out (on-pump). Fifteen patients (14 male and 1 female; mean age, 71 years; range, 50 to 79 years) had first CA revascularization without ECC followed by lung resection (off-pump). Survival was estimated by the Kaplan-Meier method and analyzed using the log-rank test and the Cox proportional hazard regression model. RESULTS Postoperative complications and hospital survival were not significantly different between groups. However, in the on-pump group late survival was significantly better. Late survival was significantly longer in patients without recurrent vessel disease and with stage I lung cancer. CONCLUSIONS These results show no significant difference in using an on-pump or off-pump technique to perform a combined cardiac and lung surgery in relation to postoperative complications and hospital survival. However, our data show a significantly longer late survival period in the on-pump group. Because the off-pump patients were older and had more advanced lung malignancy, the off-pump technique should be continued and evaluated.
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Affiliation(s)
- Micha C J Schoenmakers
- Department of Cardiothoracic Surgery and Lung Diseases, St. Antonius Hospital, Nieuwegein, The Netherlands
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Howard-Alpe GM, de Bono J, Hudsmith L, Orr WP, Foex P, Sear JW. Coronary artery stents and non-cardiac surgery. Br J Anaesth 2007; 98:560-74. [PMID: 17456488 DOI: 10.1093/bja/aem089] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The utility of interventional cardiology has developed significantly over the last two decades with the introduction of coronary angioplasty and stenting, with the associated antiplatelet medications. Acute coronary stent occlusion carries a high morbidity and mortality, and the adoption of therapeutic strategies for prophylaxis against stent thrombosis has major implications for surgeons and anaesthetists involved in the management of these patients in the perioperative period. Currently, there is limited published information to guide the clinician in the optimal care of patients who have had coronary stents inserted when they present for non-cardiac surgery. This review examines the available literature on the perioperative management of these patients. A number of key issues are identified: the role of surgery vs percutaneous coronary intervention for coronary revascularization in the preoperative period; the different types of coronary stents currently available; the emerging issues related to drug-eluting stents; the pathophysiology of coronary stent occlusion; and the recommended antiplatelet regimes that the patient with a coronary stent will be receiving. The role of preoperative platelet function testing is also discussed, and the various available tests are listed. Appropriate management by all the clinicians involved with patients with coronary stents undergoing a variety of non-cardiac surgical procedures is essential to avoid a high incidence of postoperative cardiac mortality and morbidity. The review examines the evidence available for the perioperative strategies aimed at reducing adverse outcomes in a number of different clinical scenarios.
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Affiliation(s)
- G M Howard-Alpe
- Nuffield Department of Anaesthetics, University of Oxford and John Radcliffe Hospital, UK.
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Spahn DR, Howell SJ, Delabays A, Chassot PG. Coronary stents and perioperative anti-platelet regimen: dilemma of bleeding and stent thrombosis. Br J Anaesth 2006; 96:675-7. [PMID: 16698866 DOI: 10.1093/bja/ael098] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Vicenzi MN, Meislitzer T, Heitzinger B, Halaj M, Fleisher LA, Metzler H. Coronary artery stenting and non-cardiac surgery--a prospective outcome study. Br J Anaesth 2006; 96:686-93. [PMID: 16670113 DOI: 10.1093/bja/ael083] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A 45% complication rate and a mortality of 20% were reported previously in patients undergoing non-cardiac surgery after coronary artery stenting. Discontinuation of antiplatelet drugs appeared to be of major influence on outcome. Therefore we undertook a prospective, observational multicentre study with predefined heparin therapy and antiplatelet medication in patients undergoing non-cardiac procedures after coronary artery stenting. METHODS One hundred and three patients from three medical institutions were enrolled prospectively. Patients received coronary artery stents within 1 yr before non-cardiac surgery (urgent, semi-urgent or elective). Antiplatelet drug therapy was not, or only briefly, interrupted. Heparin was administered to all patients. All patients were on an intensive/intermediate care unit after surgery. Main outcome was the combined (cardiac, bleeding, surgical, sepsis) complication rate. RESULTS Of 103 patients, 44.7% (95% CI 34.9-54.8) suffered complications after surgery; 4.9% (95% CI 1.6-11.0) of the patients died. All but two (bleeding only) adverse events were of cardiac nature. The majority of complications occurred early after surgery. The risk of suffering an event was 2.11-fold greater in patients with recent stents (<35 days before surgery) as compared with percutaneous cardiac intervention more than 90 days before surgery. CONCLUSIONS Despite heparin and despite having all patients on intensive/intermediate care units, cardiac events are the major cause for new perioperative morbidity/mortality in patients undergoing non-cardiac surgery after coronary artery stenting. The complication rate exceeds the re-occlusion rate of stents in patients without surgery (usually <1% annually). Patients with coronary artery stenting less than 35 days before surgery are at the greatest risk.
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Affiliation(s)
- M N Vicenzi
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Austria.
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Maslow A, Bert A, Ng T. Case 6-2005 thoracotomy after myocardial infarction and intracoronary stenting: a balance between myocardial recovery and procedural risk. J Cardiothorac Vasc Anesth 2005; 19:794-800. [PMID: 16326310 DOI: 10.1053/j.jvca.2005.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Brown Medical School, Providence, RI 02903, USA.
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Abstract
A 44-yr-old woman with a drug-eluting coronary stent placement two weeks before surgery suffered a myocardial infarction in the postanesthesia care unit immediately after hysterectomy. She had missed only one dose of aspirin and clopidogrel preoperatively. Early recognition of subacute stent thrombosis and urgent percutaneous coronary intervention probably prevented her death. In this case report, we highlight perioperative coronary stent issues and discuss their implications.
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Affiliation(s)
- J Thomas Murphy
- Department of Anesthesiology, University of Kentucky College of Medicine Lexington, Kentucky
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Lehot JJ, Piriou V, Durand de Gevigney G, Coriat P. Le patient à risque de thrombose de stent coronaire en période périopératoire : une situation de plus en plus fréquente. ACTA ACUST UNITED AC 2005; 24:1247-9. [PMID: 16099127 DOI: 10.1016/j.annfar.2005.07.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chiu CL, Mansor M, Majid A. Anaesthetic management of high-risk cardiac patients undergoing thoracic surgery with the support of intra-aortic balloon pump. Br J Anaesth 2005; 94:688-9; author reply 689. [PMID: 15814806 DOI: 10.1093/bja/aei544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dupuis JY, Labinaz M. Noncardiac surgery in patients with coronary artery stent: what should the anesthesiologist know? Can J Anaesth 2005; 52:356-61. [PMID: 15814748 DOI: 10.1007/bf03016276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cuthill JA, Young S, Greer IA, Oldroyd K. Anaesthetic considerations in a parturient with critical coronary artery disease and a drug-eluting stent presenting for caesarean section. Int J Obstet Anesth 2005; 14:167-71. [PMID: 15795152 DOI: 10.1016/j.ijoa.2004.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2004] [Revised: 10/01/2004] [Accepted: 10/01/2004] [Indexed: 10/25/2022]
Abstract
A parturient presented with her first symptoms of coronary artery disease at 18 weeks' gestation. Following an angiogram, a drug-eluting stent was inserted, resulting in resolution of her symptoms. The patient was prescribed anti-platelet medication including clopidogrel. She was delivered by elective caesarean section at 35 weeks under general anaesthesia. The anaesthetic management is discussed and a review of the literature presented.
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Affiliation(s)
- J A Cuthill
- Department of Anaesthesia, Princess Royal Maternity Hospital, Department of Obstetrics & Gynaecology, University of Glasgow, and Department of Cardiology, Western Infirmary, Glasgow, UK
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