Skip to main content
SpringerLink
Log in
Book cover

Thoraco-Abdominal Aorta pp 185–196Cite as

Preoperative Care of Patients with Thoraco-Abdominal Aortic Aneurysms

  • Chapter

  • 1918 Accesses

Abstract

Perioperative cardiac complications are frequently associated with non-cardiac surgery, particularly with major vascular surgery. Because major vascular surgery is high-risk surgery, patients scheduled for aortic surgery, such as those affected by thoraco-abdominal aortic aneurysm, must be investigated to quantify the cardiac risk. Obviously, when surgery is urgent, surgical repair is the priority and the patient cannot be further investigated in order to evaluate a specific risk stratification, or adequately treated to improve the clinical conditions. When surgery is not urgent, a preoperative evaluation of the patient’s risk-factors is recommended. The risk stratification allows optimization of the perioperative management and identification and determination, when possible, of the strategy to reduce the cardiac risk and to improve the outcome. Among the several medical therapies proposed to reduce the cardiac risk in non-cardiac surgery, the use of beta-blockers and statins has been extensively studied and it is recommended in high-risk surgery patients.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   229.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Poldermans D, Bax JJ, Boersma E et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J 2009;30:2769–2812

    Article  PubMed  Google Scholar 

  2. Fleisher LA, Beckman JA, Brown KA et al. ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2009; 120:e169–e276

    Article  PubMed  Google Scholar 

  3. Maddox TM. Preoperative cardiovascular evaluation for noncardiac surgery. Mt Sinai J Med 2005; 72:185–192

    PubMed  Google Scholar 

  4. Wirthlin DJ, Cambria RP. Surgery-specific considerations in the cardiac patient undergoing noncardiac surgery. Prog Cardiovasc Dis 1998;40:453–468

    Article  PubMed  CAS  Google Scholar 

  5. Devereaux PJ, Goldman L, Cook DJ et al. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 2005; 13:627–634

    Google Scholar 

  6. Landesberg G, Beattie WS, Mosseri M et al. Perioperative myocardial infarction. Circulation 2009; 119:2936–2944

    Article  PubMed  Google Scholar 

  7. Poldermans D, Hoeks SE, Feringa HH. Pre-operative risk assessment and risk reduction before surgery. J Am Coll Cardiol 2008;51:1913–1924

    Article  PubMed  Google Scholar 

  8. Schouten O, Dunkelgrun M, Feringa HH et al. Myocardial damage in high-risk patients undergoing elective endovascular or open infrarenal abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2007;33:544–549

    Article  PubMed  CAS  Google Scholar 

  9. Goldman L, Caldera DL, Nussbaum SR et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977;297:845–850

    Article  PubMed  CAS  Google Scholar 

  10. Detsky AS, Abrams HB, Forbath N et al. Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med 1986; 146:2131–1214

    Article  PubMed  CAS  Google Scholar 

  11. Lee TH, Marcantonio ER, Mangione CM et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100:1043–1049

    PubMed  CAS  Google Scholar 

  12. Boersma E, Kertai MD, Schouten O et al. Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med 2005; 118:1134–1141

    Article  PubMed  Google Scholar 

  13. Biccard BM. Relationship between the inability to climb two flights of stairs and outcome after major non-cardiac surgery: implications for the pre-operative assessment of functional capacity. Anaesthesia 2005; 60:588–593

    Article  PubMed  CAS  Google Scholar 

  14. Wang TJ, Larson MG, Levy D et al. Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med 2004;350:655–663

    Article  PubMed  CAS  Google Scholar 

  15. Omland T, Sabatine MS, Jablonski KA et al. Prognostic value of B-type natriuretic peptides in patients with stable coronary artery disease: the PEACE Trial. J Am Coll Cardiol 2007;50:205–214

    Article  PubMed  CAS  Google Scholar 

  16. Ryding ADS, Kumar S, Worthington AM, Burgess D. Prognostic value of brain natriuretic peptide in noncardiac surgery. A meta-analysis Anesthesiology 2009; 11:311–319

    Article  Google Scholar 

  17. Rodseth RN, Padayachee L, Biccard BM. A meta-analysis of the utility of preoperative brain natriuretic peptide in predicting early and intermediate-term mortality and major adverse cardiac events in vascular surgical patients. Anaesthesia 2008;63:1226–1233

    Article  PubMed  CAS  Google Scholar 

  18. Cuthbertson BH, Amiri AR, Croal BL et al. Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery. Br J Anaesth 2007;99:170–176

    Article  PubMed  CAS  Google Scholar 

  19. Etchells E, Meade M, Tomlinson G, Cook D. Semiquantitative dipyridamole myocardial stress perfusion imaging for cardiac risk assessment before noncardiac vascular surgery: a meta-analysis. J Vasc Surg 2002;36:534–540

    Article  PubMed  Google Scholar 

  20. Kertai MD, Boersma E, Bax JJ, et al. A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery. Heart 2003;89:1327–1334

    Article  PubMed  CAS  Google Scholar 

  21. Sicari R, Nihoyannopoulos P, Evangelista A et al. Stress Echocardiography Expert Consensus Statement — Executive Summary: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur Heart J 2009;30:278–289

    Article  PubMed  Google Scholar 

  22. Das MK, Pellikka PA, Mahoney DW et al. Assessment of cardiac risk before nonvascular surgery: dobutamine stress echocardiography in 530 patients. J Am Coll Cardiol 2000;35:1647–1653

    Article  PubMed  CAS  Google Scholar 

  23. Guarracino F, Puttini M, Pirelli S et al. Il razionale d’uso del betabloccante nel perioperatorio del paziente sottoposto a chirurgia non cardiaca. G Ital Cardiol 2009; 10(11–12 Suppl 2):S3–S10

    Google Scholar 

  24. Juul AB, Wetterslev J, Gluud C et al. Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial. BMJ 2006;332:1482

    Article  PubMed  Google Scholar 

  25. Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 1996;335:1713–1720

    Article  PubMed  CAS  Google Scholar 

  26. Yang H, Raymer K, Butler R et al. The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial. Am Heart J 2006; 152:983–990

    Article  PubMed  CAS  Google Scholar 

  27. Lindenauer PK, Pekow P, Wang K et al. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 2005;353:349–361

    Article  PubMed  CAS  Google Scholar 

  28. Devereaux PJ, Yang H, Yusuf S et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 2008;371:1839–1847

    Article  PubMed  CAS  Google Scholar 

  29. Schouten O, Boersma E, Hoeks S et al. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med 2009;361:980–989

    Article  PubMed  CAS  Google Scholar 

  30. Schouten O, Kertai MD, Bax JJ et al. Safety of perioperative statin use in high-risk patients undergoing major vascular surgery. Am J Cardiol 2005;95:658–660

    Article  PubMed  CAS  Google Scholar 

  31. Durazzo AE, Machado FS, Ikeoka DT et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 2004;39:967–975

    Article  PubMed  Google Scholar 

  32. Hindler K, Shaw AD, Samuels J et al. Improved postoperative outcomes associated with preoperative statin therapy. Anesthesiology 2006; 105:1260–1272

    Article  PubMed  CAS  Google Scholar 

  33. Schouten O, Hoeks SE, Welten GM et al. Effect of statin withdrawal on frequency of cardiac events after vascular surgery. Am J Cardiol 2007; 100:316–320

    Article  PubMed  CAS  Google Scholar 

  34. Williams TM, Harken AH. Statins for surgical patients. Ann Surg 2008;247:30–37

    Article  PubMed  Google Scholar 

  35. McFalls EO, Ward HB, Moritz TE et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med 2004;351:2795–2804

    Article  PubMed  CAS  Google Scholar 

  36. Howard-Alpe GM, de Bono J, Hudsmith L et al. Coronary artery stents and non-cardiac surgery. Br J Anaesth 2007;98:560–574

    Article  PubMed  CAS  Google Scholar 

  37. Poldermans D, Schouten O, Vidakovic R et al. A clinical randomized trial to evaluate the safety of a noninvasive approach in high-risk patients undergoing major vascular surgery: the DECREASE-V Pilot Study. J Am Coll Cardiol 2007;49:1763–1769

    Article  PubMed  Google Scholar 

  38. Serruys PW, Morice MC, Kappetein AP et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961–972

    Article  PubMed  CAS  Google Scholar 

  39. Nuttall GA, Brown MJ, Stombaugh JW et al. Time and cardiac risk of surgery after bare-metal stent percutaneous coronary intervention. Anesthesiology 2008; 109:588–595

    Article  PubMed  Google Scholar 

  40. Rabbitts JA, Nuttall GA, Brown MJ et al. Cardiac risk of noncardiac surgery after percutaneous coronary intervention with drug-eluting stents. Anesthesiology 2008; 109:596–604

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiothoracic Department, Pisa University Hospital, Pisa, Italy

    Fabio Guarracino & Rubia Baldassarri

Authors
  1. Fabio Guarracino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rubia Baldassarri
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Vascular Surgery, “Vita-Salute” University, IRCCS H., San Raffaele, Milan, Italy

    Roberto Chiesa , Germano Melissano  & Alberto Zangrillo ,  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Italia

About this chapter

Cite this chapter

Guarracino, F., Baldassarri, R. (2011). Preoperative Care of Patients with Thoraco-Abdominal Aortic Aneurysms. In: Chiesa, R., Melissano, G., Zangrillo, A. (eds) Thoraco-Abdominal Aorta. Springer, Milano. https://doi.org/10.1007/978-88-470-1857-0_15

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-1857-0_15

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1856-3

  • Online ISBN: 978-88-470-1857-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation