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Feringa HHH, Bax JJ, Schouten O, Poldermans D. Protecting the Heart with Cardiac Medication in Patients with Left Ventricular Dysfunction Undergoing Major Noncardiac Vascular Surgery. Semin Cardiothorac Vasc Anesth 2016; 10:25-31. [PMID: 16703231 DOI: 10.1177/108925320601000106] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with left ventricular dysfunction who are undergoing major noncardiac vascular surgery are at increased risk of adverse postoperative events. We sought to evaluate whether perioperative medication use, including angiotensin-converting enzyme (ACE) inhibitors,b-blockers, statins, and aspirin, was associated with a reduced incidence of postoperative in-hospital mortality in these high-risk patients. The study enrolled 511 patients with left ventricular dysfunction (left ventricular ejection fraction <30%) who were undergoing major noncardiac vascular surgery. Cardiac risk factors and medication use were noted before surgery. Preoperative dobutamine stress echocardiography (DSE) was performed to identify patients with stress-induced myocardial ischemia. The end point was postoperative in-hospital mortality. Univariate and multivariate logistic regression analyses were performed to evaluate the relation between perioperative medication use and mortality. The mean age of the study population was 64 ± 11 years, and 75% were men. Perioperative use of ACE inhibitors, b-blockers, statins, and aspirin was recorded in 215 (48%), 139 (27%), 107 (21%), and 125 patients (24%), respectively. Stress-induced myocardial ischemia occurred in 82 patients (16%). Sixty-four patients (13%) died. Perioperative use of ACE inhibitors (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.12-0.91), b-blockers (OR, 0.03; 95% CI, 0.01-0.26), statins (OR, 0.06; 95% CI, 0.01-0.53), and aspirin (OR, 0.13; 95% CI, 0.03-0.55), was significantly associated with a reduced incidence of mortality, after adjusting for cardiac risk factors and DSE results. In conclusion, the present study showed that the perioperative use of ACE inhibitors,b-blockers, statins, and aspirin is independently associated with a reduced incidence of in-hospital mortality in patients with left ventricular dysfunction who are undergoing major noncardiac vascular surgery.
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Affiliation(s)
- Harm H H Feringa
- Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
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Grootenboer N, Hunink M, Hoeks S, Hendriks J, van Sambeek M, Poldermans D. The Impact of Gender on Prognosis After Non-cardiac Vascular Surgery. Eur J Vasc Endovasc Surg 2011; 42:510-6. [DOI: 10.1016/j.ejvs.2011.06.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 06/15/2011] [Indexed: 11/30/2022]
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Bakker E, Ravensbergen N, Voute M, Hoeks S, Chonchol M, Klimek M, Poldermans D. A Randomised Study of Perioperative Esmolol Infusion for Haemodynamic Stability during Major Vascular Surgery; Rationale and Design of DECREASE-XIII. Eur J Vasc Endovasc Surg 2011; 42:317-23. [DOI: 10.1016/j.ejvs.2011.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
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Winkel T, Rouwet E, van Kuijk JP, Voute M, de Melis M, Verhagen H, Poldermans D. Aortic Surgery Complications Evaluated by an Implanted Continuous Electrocardiography Device: A Case Report. Eur J Vasc Endovasc Surg 2011; 41:334-6. [DOI: 10.1016/j.ejvs.2010.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022]
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Cacoub PP, Zeymer U, Limbourg T, Baumgartner I, Poldermans D, Rother J, Bhatt DL, Steg PG. Effects of adherence to guidelines for the control of major cardiovascular risk factors on outcomes in the REduction of Atherothrombosis for Continued Health (REACH) Registry Europe. Heart 2011; 97:660-7. [DOI: 10.1136/hrt.2010.213710] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Flu WJ, Van Kuijk JP, Chonchol M, Winkel TA, Verhagen H, Bax JJ, Poldermans D. TIMING OF PRE-OPERATIVE BETA-BLOCKER TREATMENT IN VASCULAR SURGERY PATIENTS: INFLUENCE ON POST-OPERATIVE OUTCOME. Racionalʹnaâ farmakoterapiâ v kardiologii 2011. [DOI: 10.20996/1819-6446-2011-7-1-94-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Cacoub P, Zeymer U, Limbourg T, Baumgartner I, Poldermans D, Röther J, Bhatt DL, Steg PG. Prise en charge des facteurs de risque cardiovasculaires : impact à trois ans sur les évènements cardiovasculaires et la mortalité dans le registre REACH Europe. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bastos Gonçalves F, Metz R, Hendriks JM, Rouwet EV, Muhs BE, Poldermans D, Verhagen HJM. Decision-making in type-B dissection: current evidence and future perspectives. J Cardiovasc Surg (Torino) 2010; 51:657-667. [PMID: 20924327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Aortic dissection is a devastating cardiovascular condition with an incidence of 3,5:100 000. It is classified according to anatomic extent, mechanism of lesion, duration from index event and course (uncomplicated vs. complicated). Intramural hematoma and penetrating aortic ulcers share many of the features of classic dissections, but tend to occur in older patients with advanced atherosclerosis. In uncomplicated type-B dissection, conservative treatment with tight blood pressure and heart rate control is safe and effective. Early stent-graft implantation may, however, result in more favorable aortic remodeling and reduced late complications. For acute complicated cases intervention is usually required. Stent-graft coverage of the entry tear frequently resolves malperfusion, but the role of the false lumen in organ perfusion must be assessed and endovascular revascularization performed if necessary. In chronic type-B dissections, coverage of the entry tear likely results in continued pressurization of the false lumen due to rigidity of the dissecting membrane and distal fenestrations. Better understanding of the different disease mechanisms involved, imaging advances and introduction of dedicated stent-grafts are expected to further improve patient outcomes in the future. Primary and secondary pharmacological prevention, stricter follow-up protocols and screening of family members may also prove valuable. Better patient selection will allow preventive treatment with low morbidity for those at higher risk of complications.
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Affiliation(s)
- F Bastos Gonçalves
- Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Winkel TA, Schouten O, Hoeks SE, Voûte MT, Chonchol M, Goei D, Flu WJ, van Kuijk JP, Lindemans J, Verhagen HJM, Bax JJ, Poldermans D. Prognosis of vascular surgery patients using a quantitative assessment of troponin T release: is the crystal ball still clear? Eur J Vasc Endovasc Surg 2010; 40:739-46. [PMID: 20884259 DOI: 10.1016/j.ejvs.2010.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 08/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac troponin T (cTnT) assays with increased sensitivity might increase the number of positive tests. Using the area under the curve (AUC) with serial sampling of cTnT an exact quantification of the myocardial damage size can be made. We compared the prognosis of vascular surgery patients with integrated cTnT-AUC values to continuous and standard 12-lead electrocardiography (ECG) changes. METHODS 513 Patients were monitored. cTnT sampling was performed on postoperative days 1, 3, 7, 30 and/or at discharge or whenever clinically indicated. If cTnT release occurred, daily measurements of cTnT were performed, until baseline was achieved. CTnT-AUC was quantified and divided in tertiles. All-cause mortality and cardiovascular events (cardiac death and myocardial infarction) were noted during follow-up. RESULTS 81/513 (16%) Patients had cTnT release. After adjustment for gender, cardiac risk factors, and site and type of surgery, those in the highest cTnT-AUC tertile were associated with a significantly worse cardiovascular outcome and long-term mortality (HR 20.2; 95% CI 10.2-40.0 and HR 4.0; 95% CI 2.0-7.8 respectively). Receiver operator analysis showed that the best cut-off value for cTnT-AUC was <0.01 days*ng m for predicting long-term cardiovascular events and all-cause mortality. CONCLUSION In vascular surgery patients quantitative assessment of cTnT strongly predicts long-term outcome.
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Affiliation(s)
- T A Winkel
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Hoogwegt M, Hoeks S, Pedersen S, Scholte op Reimer W, van Gestel Y, Verhagen H, Poldermans D. Smoking Cessation has no Influence on Quality of Life in Patients with Peripheral Arterial Disease 5 Years Post-vascular Surgery. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Flu WJ, Schouten O, van Kuijk JP, Poldermans D. Perioperative Cardiac Damage in Vascular Surgery Patients. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Helderman F, Manoch I, Breeuwer M, Kose U, Boersma H, van Sambeek M, Pattynama P, Schouten O, Poldermans D, Wisselink W, van der Steen A, Krams R. Predicting Patient-Specific Expansion of Abdominal Aortic Aneurysms. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hoeks SE, Scholte Op Reimer WJM, Lingsma HF, van Gestel Y, van Urk H, Bax JJ, Simoons ML, Poldermans D. Process of care partly explains the variation in mortality between hospitals after peripheral vascular surgery. Eur J Vasc Endovasc Surg 2010; 40:147-54. [PMID: 20547077 DOI: 10.1016/j.ejvs.2010.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 04/21/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study is to investigate whether variation in mortality at hospital level reflects differences in quality of care of peripheral vascular surgery patients. DESIGN Observational study. MATERIALS In 11 hospitals in the Netherlands, 711 consecutive vascular surgery patients were enrolled. METHODS Multilevel logistic regression models were used to relate patient characteristics, structure and process of care to mortality at 1 year. The models were constructed by consecutively adding age, sex and Lee index, then remaining risk factors, followed by structural measures for quality of care and finally, selected process of care parameters. RESULTS Total 1-year mortality was 11%, ranging from 6% to 26% in different hospitals. Large differences in patient characteristics and quality indicators were observed between hospitals (e.g., age>70 years: 28-58%; beta-blocker therapy: 39-87%). Adjusted analyses showed that a large part of variation in mortality was explained by age, sex and the Lee index (Akaike's information criterion (AIC)=59, p<0.001). Another substantial part of the variation was explained by process of care (AIC=5, p=0.001). CONCLUSIONS Differences between hospitals exist in patient characteristics, structure of care, process of care and mortality. Even after adjusting for the patient population at risk, a substantial part of the variation in mortality can be explained by differences in process measures of quality of care.
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Affiliation(s)
- S E Hoeks
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Flu WJ, Schouten O, van Kuijk JP, Poldermans D. Perioperative cardiac damage in vascular surgery patients. Eur J Vasc Endovasc Surg 2010; 40:1-8. [PMID: 20400340 DOI: 10.1016/j.ejvs.2010.03.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 03/11/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients undergoing vascular surgery are at increased risk for developing cardiac complications. Majority of patients with perioperative myocardial damage are asymptomatic. Our objective is to review the available literature addressing the prevalence and prognostic implications of perioperative myocardial damage in vascular surgery patients. METHODS An Internet-based literature search was performed using MEDLINE to identify all published reports on perioperative myocardial damage in vascular surgery patients. Only those studies published from 2000 to 2010 evaluating myocardial damage using troponin I or T, with or without symptoms of angina pectoris were included. RESULTS Thirteen studies evaluating the prevalence of perioperative myocardial ischaemia or infarction were included in the study. The incidence of perioperative myocardial ischaemia ranged from 14% to 47% and the incidence of perioperative myocardial infarction ranged from 1% to 26%. In addition, 10 studies evaluating the prognostic value of perioperative myocardial ischaemia towards postoperative mortality or the occurrence of major adverse cardiac events were included. In the retrieved studies, hazard ratios varied from 1.9 to 9.0. CONCLUSION The high prevalence and asymptomatic nature of perioperative myocardial damage, combined with a substantial influence on postoperative mortality of vascular surgery patients, underline the importance of early detection and adequate management of perioperative myocardial damage. This article provides an extended overview regarding the prevalence and prognostic value of perioperative myocardial ischaemia and infarction in vascular surgery patients. In addition, treatment options to reduce the risk of perioperative myocardial damage are provided based on the current available literature.
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Affiliation(s)
- W-J Flu
- Department of Anesthesiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Flu WJ, van Kuijk JP, Bax JJ, Poldermans D. Perioperative beta-blockers: is it still useful? Indian Heart J 2010; 62:118-122. [PMID: 21180300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- W J Flu
- Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Authors/Task Force Members, Poldermans D, Bax JJ, Boersma E, De Hert S, Eeckhout E, Fowkes G, Gorenek B, Hennerici MG, Iung B, Kelm M, Kjeldsen KP, Kristensen SD, Lopez-Sendon J, Pelosi P, Philippe F, Pierard L, Ponikowski P, Schmid JP, Sellevold OF, Sicari R, Van den Berghe G, Vermassen F, Hoeks SE, Vanhorebeek I, Vahanian A, Auricchio A, Bax JJ, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, De Caterina R, Agewall S, Al Attar N, Andreotti F, Anker SD, Baron-Esquivias G, Berkenboom G, Chapoutot L, Cifkova R, Faggiano P, Gibbs S, Hansen HS, Iserin L, Israel CW, Kornowski R, Eizagaechevarria NM, Pepi M, Piepoli M, Priebe HJ, Scherer M, Stepinska J, Taggart D, Tubaro M. Corrigendum to: 'Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA)' [Eur Heart J 2009;30:2769-2812]. Eur Heart J 2010. [DOI: 10.1093/eurheartj/ehp593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kaandorp TAM, Bax JJ, Bleeker SE, Doornbos J, Viergever EP, Poldermans D, van der Wall EE, de Roos A, Lamb HJ. Relation between regional and global systolic function in patients with ischemic cardiomyopathy after beta-blocker therapy or revascularization. J Cardiovasc Magn Reson 2010; 12:7. [PMID: 20105317 PMCID: PMC2835669 DOI: 10.1186/1532-429x-12-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Accepted: 01/27/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the relationship between improved regional and global myocardial function in patients with ischemic cardiomyopathy in response to beta-blocker therapy or revascularization. MATERIALS AND METHODS Cardiovascular magnetic resonance (CMR) was performed in 32 patients with ischemic cardiomyopathy before and 8 +/- 2 months after therapy. Patients were assigned clinically to beta-blocker therapy (n = 20) or revascularization (n = 12). CMR at baseline was performed to assess regional and global LV function at rest and under low-dose dobutamine. Wall thickening was analyzed in dysfunctional, adjacent, and remote segments. Follow-up CMR included rest function evaluation. RESULTS Augmentation of wall thickening during dobutamine at baseline was similar in dysfunctional, adjacent and remote segments in both patient groups. Therefore, baseline characteristics were similar for both patient groups. In both patient groups resting LV ejection fraction and end-systolic volume improved significantly (p < 0.05) at follow-up. Stepwise multivariate analysis revealed that improvement in global LV ejection fraction in the beta-blocker treated patients was significantly related to improved function of remote myocardium (p < 0.05), whereas in the revascularized patients improved function in dysfunctional and adjacent segments was more pronounced (p < 0.05). CONCLUSION In patients with chronic ischemic LV dysfunction, beta-Blocker therapy or revascularization resulted in a similar improvement of global systolic LV function. However, after beta-blocker therapy, improved global systolic function was mainly related to improved contraction of remote myocardium, whereas after revascularization the dysfunctional and adjacent regions contributed predominantly to the improved global systolic function.
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Affiliation(s)
- T A M Kaandorp
- Department of Radiology, Leiden University Medical Center, the Netherlands.
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van Kuijk JP, Flu WJ, Chonchol M, Welten GMJM, Verhagen HJM, Bax JJ, Poldermans D. The prevalence and prognostic implications of polyvascular atherosclerotic disease in patients with chronic kidney disease. Nephrol Dial Transplant 2010; 25:1882-8. [DOI: 10.1093/ndt/gfp756] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Flu WJ, van Kuijk JP, Voûte M, Kuiper R, Verhagen H, Bax J, Poldermans D. Asymptomatic Low Ankle-Brachial Index in Vascular Surgery Patients: A Predictor of Perioperative Myocardial Damage. Eur J Vasc Endovasc Surg 2010; 39:62-9. [DOI: 10.1016/j.ejvs.2009.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 09/06/2009] [Indexed: 10/20/2022]
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Schouten O, Sillesen H, Poldermans D. New Guidelines from the European Society of Cardiology for Perioperative Cardiac Care: A Summary of Implications for Elective Vascular Surgery Patients. Eur J Vasc Endovasc Surg 2010; 39:1-4. [DOI: 10.1016/j.ejvs.2009.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 10/05/2009] [Indexed: 11/26/2022]
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Flu WJ, van Kuijk JP, Voûte M, Kuiper R, Verhagen H, Bax J, Poldermans D. Asymptomatic Low Ankle-Brachial Index in Vascular Surgery Patients: A Predictor of Perioperative Myocardial Damage. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2009.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Winkel T, Schouten O, Voûte M, Hoeks S, Welten G, Bax J, Verhagen H, Poldermans D. The effect of statins on perioperative events in patients undergoing vascular surgery. Acta Chir Belg 2010; 110:28-31. [PMID: 20306905 DOI: 10.1080/00015458.2010.11680560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite recent advancements in perioperative care and guideline recommendations, patients undergoing vascular surgery remain at risk for perioperative cardiovascular complications. In this review, the results are summarized of the most recent studies on the effectiveness and safety of perioperative statin use for the prevention of these perioperative cardiovascular complications. Perioperative statin therapy was associated with an improvement in postoperative cardiovascular outcome and a reduction in serum lipid levels and levels of inflammation markers.
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Affiliation(s)
- T.A. Winkel
- Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - O. Schouten
- Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
- Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - M.T. Voûte
- Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - S.E. Hoeks
- Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - G.M. Welten
- Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - J.J. Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - H.J.M. Verhagen
- Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - D. Poldermans
- Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
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van Kuijk JP, Flu WJ, Welten GMJM, Hoeks SE, Chonchol M, Vidakovic R, Verhagen HJM, Bax JJ, Poldermans D. Long-term prognosis of patients with peripheral arterial disease with or without polyvascular atherosclerotic disease. Eur Heart J 2009; 31:992-9. [DOI: 10.1093/eurheartj/ehp553] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Winkel T, Schouten O, Hoeks S, Verhagen H, Bax J, Poldermans D. Prognosis of Transient New-Onset Atrial Fibrillation During Vascular Surgery. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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van Kuijk J, Schouten O, Flu W, den Uil C, Bax J, Poldermans D. Perioperative Blood Glucose Monitoring and Control in Major Vascular Surgery Patients. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bongers T, de Bruijne E, Dippel D, de Jong A, Deckers J, Poldermans D, de Maat M, Leebeek F. Lower levels of ADAMTS13 are associated with cardiovascular disease in young patients. Atherosclerosis 2009; 207:250-4. [DOI: 10.1016/j.atherosclerosis.2009.04.013] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Revised: 04/05/2009] [Accepted: 04/06/2009] [Indexed: 01/21/2023]
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Vidakovic R, Schouten O, Kuiper R, Hoeks S, Flu WJ, van Kuijk J, Goei D, Verhagen H, Neskovic A, Poldermans D. The Prevalence of Polyvascular Disease in Patients Referred for Peripheral Arterial Disease. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vidakovic R, Schouten O, Kuiper R, Hoeks S, Flu WJ, van Kuijk J, Goei D, Verhagen H, Neskovic A, Poldermans D. The Prevalence of Polyvascular Disease in Patients Referred for Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2009; 38:435-40. [DOI: 10.1016/j.ejvs.2009.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 05/10/2009] [Indexed: 11/16/2022]
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van Kuijk J, Flu W, Bax J, Poldermans D. Prevalence of (A)Symptomatic Peripheral Arterial Disease; the Additional Value of Ankle–Brachial Index on Cardiovascular Risk Stratification. Eur J Vasc Endovasc Surg 2009; 38:312-3. [DOI: 10.1016/j.ejvs.2009.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 05/01/2009] [Indexed: 11/26/2022]
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van Gestel YRBM, Hoeks SE, Sin DD, Huzeir V, Stam H, Mertens FW, van Domburg RT, Bax JJ, Poldermans D. COPD and cancer mortality: the influence of statins. Thorax 2009; 64:963-7. [DOI: 10.1136/thx.2009.116731] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Flu WJ, van Kuijk JP, Bax JJ, Gorcsan J, Poldermans D. Three-dimensional speckle tracking echocardiography: a novel approach in the assessment of left ventricular volume and function? Eur Heart J 2009; 30:2304-7. [DOI: 10.1093/eurheartj/ehp343] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Winkel TA, Schouten O, Hoeks SE, Verhagen HJM, Bax JJ, Poldermans D. Prognosis of transient new-onset atrial fibrillation during vascular surgery. Eur J Vasc Endovasc Surg 2009; 38:683-8. [PMID: 19683947 DOI: 10.1016/j.ejvs.2009.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 07/10/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic atrial fibrillation (AF) in a non-surgical setting is associated with cardiovascular events. However, the prognosis of transient new-onset AF during vascular surgery is unknown. OBJECTIVE The purpose of this study is to investigate the prognosis of new-onset AF during vascular surgery using continuous electrocardiographic monitoring (continuous-ECG). METHODS In this study, 317 patients, all in sinus rhythm, scheduled for major vascular surgery were screened for cardiac risk factors. Continuous-ECG recordings for 72h and standard ECG on days 3, 7 and 30 were used to identify new-onset AF. Cardiac troponin T (cTnT) was measured routinely after surgery. Study endpoint was a composite of cardiac death, myocardial infarction, unstable angina and stroke (cardiovascular events) at 30 days after surgery and during late follow-up. Median follow-up was 12 (interquartile range 2-28) months. RESULTS New-onset AF was noted in 15 (4.7%) patients. All but three patients returned spontaneously to sinus rhythm. The composite endpoint of cardiovascular events within 30 days and during late follow-up occurred in 34 (11%) and 62 (20%) patients, respectively. Multivariate regression analysis showed that new-onset AF was associated with perioperative (hazard ratio (HR) 6.0; 95% CI: 2.4-15) and late cardiovascular events (HR 4.2, 95% CI: 2.1-8.8). CONCLUSION New-onset AF during vascular surgery is associated with an increased incidence of 30-day and late cardiovascular events.
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Affiliation(s)
- T A Winkel
- Department of Vascular Surgery, Erasmus MC, 's Gravendijkwal 230, Rotterdam, The Netherlands
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Rizzello V, Poldermans D, Biagini E, Schinkel AFL, Boersma E, Boccanelli A, Marwick T, Roelandt JRTC, Bax JJ. Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: relation to viability and improvement in left ventricular ejection fraction. Heart 2009; 95:1273-7. [PMID: 19443475 DOI: 10.1136/hrt.2008.163972] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In patients with ischaemic cardiomyopathy and viable myocardium, left ventricular ejection fraction (LVEF) does not always improve after revascularisation. Whether this may affect prognosis is unclear. OBJECTIVE To evaluate the prognosis of viable patients with and without improvement of LVEF after coronary revascularisation. METHODS Before revascularisation, radionuclide ventriculography (RNV) and dobutamine stress echocardiography were performed to assess LVEF and myocardial viability, respectively. Nine to 12 months after revascularisation, LVEF improvement was assessed by RNV. Patients were divided into three groups: group 1, viable patients with LVEF improvement (n = 27); group 2, viable patients without LVEF improvement (n = 15), group 3, non-viable patients (n = 48). Cardiac events were evaluated during a 4-year follow-up. RESULTS After revascularisation, the mean (SD) LVEF improved from 32 (9)% to 42 (10)% in group 1, but did not change significantly in group 2 and in group 3, p<0.001 by analysis of variance (ANOVA). Heart failure symptoms improved in both groups 1 (mean (SD) NYHA class from 3.1 (0.9) to 1.7 (0.7)) and 2 (from 3.2 (0.7) to 1.7 (0.9)), but not in group 3 (from 2.8 (1.0) to 2.7 (0.5)), p<0.001 by ANOVA. During follow-up, the cardiac event rate was low (4%) in group 1, intermediate (21%) in group 2 and high (33%) in group 3 (p = 0.01). CONCLUSION The best prognosis after revascularisation may be expected in those viable patients whose LVEF improves. Conversely, viable patients without functional improvement have an intermediate prognosis.
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Affiliation(s)
- V Rizzello
- Department of Cardiovascular Disease, San Giovanni-Addolorata Hospital, Via dell' Amba Aradam 8, 00184 Rome, Italy.
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van Kuijk JP, Schouten O, Flu WJ, den Uil CA, Bax JJ, Poldermans D. Perioperative blood glucose monitoring and control in major vascular surgery patients. Eur J Vasc Endovasc Surg 2009; 38:627-34. [PMID: 19608440 DOI: 10.1016/j.ejvs.2009.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 06/13/2009] [Indexed: 01/08/2023]
Abstract
Diabetes mellitus (DM) is an independent predictor for morbidity and mortality in the general population, which is even more apparent in patients with concomitant cardiovascular risk factors. As the prevalence of DM is increasing, with an ageing general population, it is expected that the number of diabetic patients requiring surgical interventions will increase. Perioperative hyperglycaemia, without known DM, has been identified as a predictor for morbidity and mortality in patients undergoing surgery. Moreover, early studies showed that intensive blood-glucose-lowering therapy reduced both morbidity and mortality among patients admitted to the postoperative intensive care unit (ICU). However, later studies have doubted the benefit of intensive glucose control in medical-surgical ICU patients. This article aims to comprehensively review the evidence on the use of perioperative intensive glucose control, and to provide recommendations for current clinical practice. A systematic review was performed of the literature on perioperative intensive glucose control. Based on this literature review, we observed that intensive glucose control in the perioperative period has no clear benefit on short-term mortality. Intensive glucose control may even have a net harmful effect in selected patients. In addition, concerns on the external validity of some studies are important barriers for widespread recommendation of intensive glucose control in the perioperative setting. We propose that guidelines recommending intensive glucose control should be re-evaluated. In addition, moderate tight glucose control should currently be regarded as the safest and most efficient approach to patients undergoing major vascular surgery.
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Affiliation(s)
- J P van Kuijk
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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Flu WJ, van Kuijk JP, Merks EJ, Kuiper R, Verhagen HJ, Bosch JG, Bom N, Bax JJ, Poldermans D. Screening for abdominal aortic aneurysms using a dedicated portable ultrasound system: early results. European Journal of Echocardiography 2009; 10:602-6. [DOI: 10.1093/ejechocard/jep081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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de Bruijne ELE, Gils A, Guimarães AHC, Dippel DWJ, Deckers JW, van den Meiracker AH, Poldermans D, Rijken DC, Declerck PJ, de Maat MPM, Leebeek FWG. The role of thrombin activatable fibrinolysis inhibitor in arterial thrombosis at a young age: the ATTAC study. J Thromb Haemost 2009; 7:919-27. [PMID: 19323787 DOI: 10.1111/j.1538-7836.2009.03350.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Thrombin activatable fibrinolysis inhibitor (TAFI) attenuates fibrinolysis and may therefore contribute to the pathophysiology of arterial thrombosis. The aim of the present study was to elucidate the pathogenetic role of TAFI levels and genotypes in young patients with arterial thrombosis. PATIENTS AND METHODS In a case-control study, 327 young patients with a recent first-ever event of coronary heart disease (CHD subgroup) or cerebrovascular disease (ischemic stroke subgroup) and 332 healthy young controls were included. TAFI levels [intact TAFI, activation peptide (TAFI-AP) and (in)activated TAFI (TAFIa(i)] and TAFI activity were measured and genetic variations in the TAFI gene (-438G/A, 505G/A and 1040C/T) were determined. RESULTS In the total group of patients, TAFIa(i) levels were higher (145.1 +/- 37.5%) than in controls (137.5 +/- 31.3%, P = 0.02). Plasma levels of intact TAFI, TAFI-AP and TAFI activity were similar in patients and controls. In the CHD subgroup (n = 218), intact TAFI levels were higher (109.4 +/- 23.0%) than in controls (102.8 +/- 20.7%, P = 0.02). In 325Ile/Ile homozygotes, lower TAFI levels and a decreased risk of arterial thrombosis were observed (OR 0.58, 95% CI 0.34-0.99) compared with patients with the common 325Thr/Thr genotype. This association was most evident in CHD patients (OR 0.48, 95% CI 0.26-0.90). Haplotype analyses supported a role for the Thr325Ile polymorphism. CONCLUSIONS TAFIa(i) levels were higher in patients with cardiovascular disease. Furthermore, the TAFI 325Thr/Ile polymorphism was associated with lower TAFI levels and with the risk of cardiovascular disease in young patients, especially in CHD.
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Affiliation(s)
- E L E de Bruijne
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Welten GMJM, Schouten O, Chonchol M, Hoeks SE, Bax JJ, Van Domburg RT, Poldermans D. Prognosis of patients with peripheral arterial disease. J Cardiovasc Surg (Torino) 2009; 50:109-121. [PMID: 19179996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The incidence of peripheral arterial disease (PAD) is on the increase and is associated with a major health concern in current practical care. The most common disease process underlying PAD is atherosclerosis. Atherosclerosis is a complex generalized disease affecting several arterial beds, including the peripheral and coronary circulation. Especially in patients with PAD, high incidences of coronary artery disease (CAD) have been observed, which may be asymptomatic or symptomatic. The prognosis of patients with PAD is related to the presence and extent of underlying CAD. In patients with PAD undergoing major vascular surgery, cardiac complications are the major cause of perioperative morbidity and mortality and indicate a high-risk for adverse long-term cardiac outcome. In order to improve outcome for PAD patients, assessment and aggressive therapy of atherosclerotic risk factors and usage of cardio-protective medications is recommended. Unfortunately, substantial differences in risk factor management and treatment and long-term outcome have been reported between PAD and CAD patients.
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Affiliation(s)
- G M J M Welten
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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Van Kuijk JP, Flu WJ, Dunckelgrun M, Bax JJ, Poldermans D. Coronary artery disease in patients with abdominal aortic aneurysm: a review article. J Cardiovasc Surg (Torino) 2009; 50:93-107. [PMID: 19179995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Abdominal aortic aneurysms (AAA) and coronary artery disease (CAD) have traditionally been regarded as two separate vessel disorders with a common background. Atherosclerosis has always been considered as the basic pathophysiologic process. However, during the last decade, evidence has emerged with differences between AAA and CAD. Firstly, data regarding the prevalence of AAA and CAD are different. Secondly, the risk profiles between AAA and CAD differ, mainly regarding gender, age and diabetes mellitus. Thirdly, despite the intensive treatment of CAD and improved outcome, the prevalence of AAA has not changed during the last decade. In this review we will discuss the characteristics of CAD in patients with AAA. In the first part we focus on epidemiological data of CAD in AAA patients. The pathophysiology of both AAA and CAD will be described in the second part. There is a common pathway between pathophysiology and risk profiles that is discussed in the third chapter. Based on the presence of risk factors and their influence on cardiovascular events, the preoperative work-up and testing for CAD in AAA has gained an important role. The role of (non)-invasive testing will be described in the fourth chapter. The treatment of AAA traditionally consisted solely of surgery. However, due to the influence of CAD on adverse outcomes, medical intervention is potentially useful. Surgical approaches for the treatment of both AAA and CAD, and most importantly, their influence on long-term outcome will be discussed in the fifth chapter.
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Affiliation(s)
- J P Van Kuijk
- Department of Anesthesiology, Erasmus Medical Centre, The Netherlands
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Schouten O, Lever T, Welten G, Winkel T, Dols L, Bax J, van Domburg R, Verhagen H, Poldermans D. Long-Term Cardiac Outcome in High-Risk Patients Undergoing Elective Endovascular or Open Infrarenal Abdominal Aortic Aneurysm Repair. J Vasc Surg 2008. [DOI: 10.1016/j.jvs.2008.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Feringa HHH, Bax JJ, Poldermans D. [Perioperative risk reduction in vascular surgery via cardio-protective medication]. Ned Tijdschr Geneeskd 2008; 152:2606-2611. [PMID: 19102435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cardiovascular complications are the leading cause of death after noncardiac surgery. Preoperative identification of patients with underlying coronary artery disease is important, and appropriate treatment strategies should be implemented in these patients in order to reduce the risk of perioperative complications. Based on recent findings, preoperative risk stratification models have been developed to identify high-, intermediate- or low-risk patients; the concentration of natriuretic peptides is a promising new preoperative risk marker. beta-blockers considerably reduce this risk. In clinical practice, important factors are adequate beta-blocker dosage, tight perioperative heart-rate control and continuation of beta-blockers after discharge. Recently, statins have emerged as drugs with perioperative cardioprotective properties, but more randomized clinical trials are needed before routine administration ofstatins can be recommended. Perioperative medical management should focus on improvements not only in the short-term but also in the long-term.
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Affiliation(s)
- H H H Feringa
- Afd. Cardiologie, Erasmus MC-Centrum, Dr.Molewaterplein 40, 3015 GD Rotterdam
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Damen J, Hagemeijer JW, van den Broek L, Poldermans D. [Prevention of perioperative cardiac complications in non-cardiac surgery: an evidence-based guideline]. Ned Tijdschr Geneeskd 2008; 152:2612-2616. [PMID: 19102436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Approximately 2.5% of the patients undergoing non-cardiac surgery suffer from perioperative cardiac complications. These are associated with a mortality of 20.60%, a longer stay in hospital and higher costs. The risk factors for perioperative cardiac complications are: high-risk surgery, ischaemic heart disease, a history of congestive heart failure, cerebrovascular disease, diabetes, and renal failure. Recently, the scope of medical management has shifted from assessing and treating underlying culprit coronary lesions toward coronary plaque stabilisation and prevention of myocardial oxygen supply demand mismatch. Currently, the prevention of cardiac problems consists of identification of the patients at risk, optimisation of the preoperatieve condition by modification of underlying risk factors, optimisation of the perioperative medication with adrenergic beta-antagonists, statins, and acetylsalicylic acid, adequate perioperative monitoring and measures to prevent myocardial ischaemia. These include adequate sedation and analgesia, adequate oxygenation, oxygen transport, and ventilation, and if necessary additional cardiac medication.
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Affiliation(s)
- J Damen
- Universitair Medisch Centrum St Radboud, afd. Anesthesiologie, Huispost 550, Postbus 9101, 6500 HB Nijmegen.
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Smolderen K, Hoeks S, Aquarius A, Scholte op Reimer W, Spertus J, van Urk H, Denollet J, Poldermans D. Further Validation of the Peripheral Artery Questionnaire: Results from a Peripheral Vascular Surgery Survey in the Netherlands. Eur J Vasc Endovasc Surg 2008; 36:582-91. [DOI: 10.1016/j.ejvs.2008.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
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Smolderen K, Hoeks S, Aquarius A, Scholte op Reimer W, Spertus J, van Urk H, Denollet J, Poldermans D. Further Validation of the Peripheral Artery Questionnaire: Results from a Peripheral Vascular Surgery Survey in the Netherlands. J Vasc Surg 2008. [DOI: 10.1016/j.jvs.2008.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schouten O, Lever TM, Welten GMJM, Winkel TA, Dols LFC, Bax JJ, van Domburg RT, Verhagen HJM, Poldermans D. Long-term cardiac outcome in high-risk patients undergoing elective endovascular or open infrarenal abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2008; 36:646-52. [PMID: 18922711 DOI: 10.1016/j.ejvs.2008.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 09/11/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess long-term outcome of patients at high cardiac risk undergoing endovascular or open AAA repair. METHODS Patients undergoing open or endovascular infrarenal AAA repair with >or=3 cardiac risk factors and preoperative cardiac stress testing (DSE) at 2 university hospitals were studied. Main outcome was cardiac event free and overall survival. Multivariate Cox regression analysis was used to evaluate the influence of type of AAA repair on long-term outcome. RESULTS In 124 patients (55 endovascular, 69 open) the number and type of cardiac risk factors, medication use and DSE results were similar in both groups. In multivariable analysis, adjusting for cardiac risk factors, stress test results, medication use, and propensity score endovascular repair was associated with improved cardiac event free survival (HR 0.54; 95% CI 0.30-0.98) but not with an overall survival benefit (HR 0.73; 95% CI 0.37-1.46). Importantly, statin therapy was associated with both improved overall survival (HR 0.42; 95% CI 0.21-0.83) and cardiac event free survival (HR 0.45; 95% CI 0.23-0.86). CONCLUSIONS The perioperative cardiac benefit of endovascular AAA repair in high cardiac risk patients is sustained during long-term follow-up provided patients are on optimal medical therapy but it is not associated with improved overall long-term survival.
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Affiliation(s)
- O Schouten
- Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
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Poldermans D, Dunkelgrun M, Schouten O, Hostalek U. Prolonged-release nicotinic acid in patients with atherosclerotic disease in the Netherlands. Eur Surg Res 2008; 41:313-8. [PMID: 18799884 DOI: 10.1159/000155896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 05/05/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVES High-density lipoprotein (HDL) cholesterol elevation is associated with an improved outcome in patients with atherosclerotic disease. Niaspan, a prolonged-release nicotinic acid, was evaluated during the Niaspan-Induced HDL Elevation for Optimizing Risk Control (NEMO) study in The Netherlands. METHODS NEMO was a 6-month, prospective, observational, multicentre, open-label study. Niaspan was prescribed in statin-treated patients with known or suspected atherosclerotic disease. The main outcome measures were treatment-related adverse drug reactions (ADRs) and effects on lipids and cardiovascular-risk score based on the algorithm derived from the Prospective Cardiovascular Münster study. RESULTS 612 patients were included in The Netherlands. Flushing was the most common ADR (29% of patients during the first month of treatment). The main reasons for treatment discontinuation were flushing (10.5%), patient request (8.0%) and being lost to follow-up (6.0%). About half of all patients (52%) continued treatment after the study. Tolerability was rated 'good' or 'very good' in 54% of these patients. HDL cholesterol increased by 23% from baseline, and triglycerides were reduced by 16%, with little change in low-density lipoprotein or total cholesterol. Cardiovascular risk score was reduced by 3.3 points. CONCLUSIONS The use of the prolonged-release nicotinic acid Niaspan in patients with or at risk for atherosclerotic disease showed good tolerability, a marked increase in HDL cholesterol and a reduced cardiovascular risk score.
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Affiliation(s)
- D Poldermans
- Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Helderman F, Manoch IJ, Breeuwer M, Kose U, Schouten O, van Sambeek MRM, Poldermans D, Pattynama PTM, Wisselink W, van der Steen AFW, Krams R. A numerical model to predict abdominal aortic aneurysm expansion based on local wall stress and stiffness. Med Biol Eng Comput 2008; 46:1121-7. [PMID: 18521644 DOI: 10.1007/s11517-008-0358-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Accepted: 05/18/2008] [Indexed: 11/29/2022]
Abstract
Aneurysms of the abdominal aorta enlarge until rupture occurs. We assume that this is the result of remodelling to restore wall stress. We developed a numerical model to predict aneurysm expansion based on this assumption. In addition, we obtained aneurysm geometry of 11 patients from computed tomography angiographic images to obtain patient specific calculations. The assumption of a wall stress related expansion indeed resulted in a series of local expansions, adjusting global geometry in an exponential fashion similar as in patients. Furthermore, it revealed that location of peak wall stress changed over time. The assumptions of this model are discussed in detail in this manuscript, and the implications are related to literature findings.
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Affiliation(s)
- F Helderman
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
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Nucifora G, Marsan NA, Siebelink HMJ, van Werkhoven JM, Schuijf JD, Schalij MJ, Poldermans D, Holman ER, Bax JJ. Safety of contrast-enhanced echocardiography within 24 h after acute myocardial infarction. European Journal of Echocardiography 2008; 9:816-8. [DOI: 10.1093/ejechocard/jen167] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Dunkelgrun M, Hoeks SE, Schouten O, Feringa HHH, Welten GMJM, Vidakovic R, Van Gestel YRBM, Van Domburg RT, Goei D, De Jonge R, Lindemans J, Poldermans D. Methionine loading does not enhance the predictive value of homocysteine serum testing for all-cause mortality or major adverse cardiac events. Intern Med J 2008; 39:13-8. [DOI: 10.1111/j.1445-5994.2007.01596.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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