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Patients who receive a drug-eluting coronary artery stent (DES) will be placed on dual antiplatelet therapy (DAPT) for a period of six months to a year to prevent platelet activation and thrombosis of the stent. Non-cardiac surgery should be delayed until the patient has completed DAPT. If surgery has to be performed before the stipulated time required for DAPT, a multidisciplinary approach should be taken, involving a cardiologist, surgeon and anaesthetist. Stopping DAPT and risking stent failure must be weighed up against the risks of expected surgical bleeding. All patients who are scheduled for surgery within the stipulated period, should be managed perioperatively in a high dependency unit and in a hospital where 24-hour catheterisation laboratory (cath lab) services are available. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Western populations experiencing greater number of degenerative valve disease. Topics include secondary causes such as ischaemic heart disease being the most commonly encountered valvular lesions in Western countries; and ventricle being no longer compensate, causing secondary LV cavity enlargement, LV failure, reduced ejection fraction (EF), decreased cardiac output. s.

The article highlights a study on the combination of careful perioperative considerations, less invasive surgeries and the liberal use of neuro-axial techniques has decreased perioperative major adverse cardiac events (MACE) and overall mortality in vascular surgical patients.

Congenital heart disease is the most commonly occurring congenital anomaly. 95% of patients with mild to moderate lesions will now survive to adulthood, as will 69% of patients with critical disease. These patients are likely to present for non-cardiac surgery. Assessing risk of anaesthesia in these patients is important as they are at increased risk for perioperative morbidity and mortality. New physiological classifications of congenital heart disease are discussed, as are factors associated with increased risk in these patients. Patients with high and moderate risk should ideally be referred to a unit familiar with congenital heart disease. [ABSTRACT FROM AUTHOR]

Background: A plethora of studies have shown elevated preoperative natriuretic peptide measurements to predict postoperative mortality and adverse cardiac events. Objectives: The current study aimed to demonstrate this overwhelming association and to show that further studies of this nature are unwarranted. Methods: A cumulative meta-analysis of 28 studies was conducted where the primary outcomes of mortality and adverse cardiac events were associated with elevated preoperative natriuretic peptides. Results: Cumulative meta-analysis demonstrated an odds ratio trending to a constant of 5.66, with a marked narrowing in the 95% confidence interval. Conclusions: Further studies aiming only to demonstrate an association between a preoperative natriuretic peptide threshold and the risk of postoperative adverse cardiac events are not justified. Future investigation should focus on the clinical implications of these data and the application of these findings with regard to further investigation, optimisation and appropriate adaptation of perioperative management. [ABSTRACT FROM AUTHOR]

Thalassaemia is a rare hereditary disease caused by partial or complete deficiency of β-haemoglobin chain synthesis. There is a lot of literature regarding anaesthetic management in other haemoglobinopathies (i.e. sickle cell disease), especially in the paediatric population, but there is scarce information regarding β-thalassaemia major in adults. With current medical management, β-thalassaemia major patients survive to adulthood and may present for a variety of surgical procedures, even unrelated to their disease process. It is important for the anaesthetist to be familiar with the pathophysiology of β-thalassaemia major and how the disease itself and its treatment or complications (iron deposition from multiple transfusions) can affect anaesthesia. A case of a 51-year-old woman with severe β-thalassaemia undergoing laparoscopic cholecystectomy is presented. The anaesthetic management and systematic review of the perioperative concerns in severe β-thalassaemia are discussed. [ABSTRACT FROM AUTHOR]

The article focuses on the European Surgical Outcomes Study (EuSOS), collaborative study designed to assess outcomes following non-cardiac surgery across Europe. Topics discussed include higher mortality rate for patients undergoing inpatient non-cardiac surgery, evidence of heterogeneity between hospitals and healthcare systems and length of stay and admission to intensive care in a large prospective observational study in South African government hospitals.

Objectives: The objective was to determine the diagnostic criteria of a prognostically important troponin elevation following non-cardiac surgery. Background: A postoperative troponin leak following non-cardiac surgery is independently associated with 30- day mortality. Importantly, even what was previously considered to be an insignificant troponin leak has been independently associated with 30-day mortality in unselected surgical patients = 45 years of age. Method: This study forms part of the prospective observational study known as the VISION (Vascular Events In Noncardiac Surgery Patients Cohort Evaluation) study.1 Diagnostic criteria were established for prognostically important myocardial injury following non-cardiac surgery from 15 000+ patients. A Cox regression analysis was undertaken to determine the independent predictors of 30-day mortality following non-cardiac surgery. The potential independent variables entered into the regression included preoperative variables, perioperative complications, and possible diagnostic criteria for myocardial injury after non-cardiac surgery. Results: Elevated troponin after non-cardiac surgery (without any evidence of a non-ischaemic cause like sepsis), independently predicted 30-day mortality. The presence of an ischaemic feature, as required for the Universal definition of myocardial infarction, did not change the diagnostic performance of the elevated troponin alone. Conclusion: Myocardial injury after non-cardiac surgery should be considered a new clinical entity. A troponin leak alone is considered to be prognostically important. The presence of ischaemic features should not be considered as a criterion for intervention in troponin-positive patients following non-cardiac surgery. [ABSTRACT FROM AUTHOR]