Non-Cardiac Surgery After Percutaneous Coronary Interventions

Yıl 2009, Cilt: 12 Sayı: 1, 39 - 45, 01.01.2008

Yunus Emiro¤lu Selçuk Pala Bilal Boztosun

Öz

In accordance with the trend of the world, the treatment with coronary intervention has become widespread in our country. With improvement in life standards, the average life expectancy has also increased. Non-cardiac surgery was performed in approximately 5 % of the patients who underwent percutaneous coronary interventions. The timing of non-cardiac surgery is well-defined in cases of bare metal stents which are most widely used in percutaneous coronary interventions. Unfortunately, we still do not know the optimal timing for surgery in cases of drug-eluting stents which are increasingly preferred for lesser restenosis. The stent-implanted patients have always been challenges for various surgeons. We tried to review the timing for non-cardiac surgeries, surgical techniques and stent-related problems in these patients.

Anahtar Kelimeler

Percutaneous coronary intervention, stenting, clopidogrel, non cardiac surgery

Perkütan Koroner Giriflim Sonras› Kalp D›fl› Cerrahi

Öz

Perkütan koroner girflimler ile tedavi dünyada oldu¤u gibi ülkemizde de yayg›nlaflm›flt›r. Toplulumuzun yaflam flartlar›n›n iyileflmesi ile yafl ortalamas› yükselmifltir. Perkütan koroner tedavi yap›lan hastalar›n yaklafl›k olarak yüzde befline kalp d›fl› cerrahi gerekmektedir. Perkütan koroner tedavide yayg›n olarak kulland›¤›m›z bare metal stentlerde kalp d›fl› cerrahi zaman› netleflmifltir. Restenoz oran› ilaç sal›n›ml› stentler ile önemli oranda çözülmüflken bu hastalarda optimal kalp d›fl› cerrahi zaman› belli de¤ildir. Koroner arter problemlerini stentler ile çözüme ulaflt›r›lan hastalar kardiyovasküler cerrahlar d›fl›ndaki cerrahlar taraf›ndan her zaman önemli problem olarak görülmektedirler. Bu hastalarda kalp d›fl› cerrahi zamanlar›,cerrahi teknikleri ve stentler ile ilgili problemleri gözden geçirdik.

Anahtar Kelimeler

Perkütan koroner giriflim, stentleme, klopidogrel, kalp d›fl› cerrahi

Kaynakça

• Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics 2006 update: A report from the American Heart Association Statistics Commit- tee and Stroke Statistics Subcommittee. Circulation 2006; 113:e85–e151.
• Serruys PW, Kutryk MJB, Ong ATL. Coronary-artery stents. N Engl J. Med 2006; 354:483–495.
• Tu JV, Bowen J, Chiu M, Ko DT, Austin PC, He Y, Hopkins R, Tarride JE, Blackhouse G, Lazzam C, Cohen EA, Goeree R: Effectiveness and safety of drug-eluting stents in Ontario. N Engl J Med 2007; 357:1393–402
• McLean TR: In New York State, do more percutaneo- us coronary interventions mean fewer or more complex referrals to cardiac surgeons? Am Heart Hosp J 2008; :588–95
• Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidog- rel in addition to aspirin in patients with acute coronary syndromes without ST-segment in elevation. N Engl J Med 2001; 345:494–502.
• Mehta SR, Yusuf S, Peters RJG, et al. Effects of pret- reatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percuta- neous coronary intervention: the PCI-CURE study. Lancet2001; 358:527–533.
• ACC/AHA Ua -Nstemı Guıdeline Revision,Circulation, August 14 p.184) Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, Airoldi F, Chieffo A, Montorfano M, Carlino M, Michev I, Corvaja N, Briguori C, Gerckens U, Grube E, Colombo A: Incidence, predictors, and outco- me of thrombosis after successful implantation of drug- eluting stents. JAMA 2005; 293:2126–30
• Pfisterer M, Brunner-La Rocca HP, Buser PT, Ricken- bacher P, Hunziker P, Mueller C, Jeger R, Bader F, Oss- wald S, Kaiser C: Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: An observational study of drug-eluting versus bare-metal stents. J Am Coll Cardiol 2006; 48:2584–91
• Ferrari E, Benhamou M, Cerboni P, et al. Coronary syndromes following aspirin withdrawal. A special risk for late stent thrombosis. J Am Coll Cardiol 2005; 45:456–459.
• Pfisterer M, Brunner La-Rocca HP,Buser PT, etal. Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents. J Am Coll Cardiol 2006; 48:2584–2591.
• Spertus JA, Kettelkampf R, Vance C, et al. Prevalen- ce, predictors, and outcomes of premature discontinu- ation of thienopyridine therapy after drug-eluting stent placement (Results form the PREMIER Registry). Circu- lation 2006; 113:2803–2809.
• Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, Airoldi F, Chieffo A, Montorfano M, Carlino M, Michev I, Corvaja N, Briguori C, Gerckens U, Grube E, Colombo A. Incidence, predictors, and outco- me of thrombosis after successful implantation of drug- eluting stents. JAMA. 2005;293:2126–2130.
• Kaluza GL, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of non-cardiac surgery so- on after coronary stenting. J Am Coll Cardiol. ;35:1288 –1294.
• Vicenzi MN, Meislitzer T, Heitzinger B, Halaj M, Fle- isher LA, Metzler H. Coronary artery stenting and non- cardiac surgery: a prospective outcome study. Br J Anaesth. 2006;96:686–693.
• Wilson SH, Fasseas P, Orford JL, Lennon RJ, Hor- locker T, Charnoff NE, Melby S, Berger PB. Clinical out- come of patients undergoing non-cardiac surgery in the two months following coronary stenting. JAm Coll Car- diol. 2003;42:234 –240.
• Kaluza GL, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol 2000;35:1288–94.
• Wilson SH, Fasseas P, Orford JL, et al. Clinical out- come of patients undergoing noncardiac surgery in the two months following coronary stenting. J Am Coll Car- diol 2003;42:234 –40.
• Sharma AK, Ajani AE, Hamwi SM, et al. Major non- cardiac surgery following coronary stenting: when is it safe to operate? Catheter Cardiovasc Interv ;63:141–5 McFadden EP, Stabile E, Regar E, et al. Late throm- bosis in drug-eluting coronary stents after discontinuati- on of antiplatelet therapy. Lancet 2004;364:1519–21.
• Compton PA, Zankar AA, Adesanya AO, Banerjee S, Brilakis ES. Risk of noncardiac surgery after coronary drug-eluting stent implantation. Am J Cardiol ;98:1212–3.
• Schouten O, vanDomburg RT, Bax JJ, et al. Noncar- diac surgery after coronary stenting: early surgery and interruption of antiplatelet therapy are associated with an increase in major adverse cardiac events. J Am Coll Cardiol 2007;49:122–4.
• Bakhru M, Saber W, Brotman D, et al. Is discontinu- ation of antiplatelet therapy after 6 months safe in pati- ents with drug-eluting stents undergoing noncardiac surgery? Cleve Clin J Med 2006;73:S23.
• Fleron MH, Dupuis M, Mottet P, LeFeuvre C, Godet G. Non cardiac surgery in patient with coronary sten- ting: think sirolimus now Ann Fr Anesth Reanim ;22:733–5. McFalls EO, Ward HB, Moritz TE, et al. Coronary-ar- tery revascularization before elective major vascular surgery. N Engl J Med 2004;351:2795–804.
• Poldermans D, Schouten O, Vidakovic R, et al., DEC- REASE Study Group. A clinical randomized trial to eva- luate the safety of a JACC Vol. 49, No. 22, 2007 June 5, :2145–50 noninvasive approach in high-risk pati- ents undergoing major vascular surgery: the DECREA
• SE-V pilot study. J Am Coll Cardiol 2007;
• Huber KC, Evans MA, Bresnahan JF, Gibbons RJ, Holmes DR Jr. Outcome of noncardiac operations in pa- tients with severe coronary artery disease successfully treated preoperatively with coronary angioplasty. Mayo Clin Proc 1992;67:15–21.
• Brilakis ES, Orford JL, Fasseas P, et al. Outcome of pa- tients undergoing balloon angioplasty in the two months prior to noncardiac surgery. Am J Cardiol 2005;96:512–4.
• Eagle KA, Berger PB, Calkins H, et al. ACC/AHA gu- ideline update for perioperative cardiovascular evaluati- on for noncardiac surgery executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Com- mittee to Update the 1996 Guidelines on Perioperative
• Cardiovascular Evaluation for Noncardiac Surgery). Cir- culation 2002;105: 1257–67.
• McFadden EP, Stabile E, Regar E, et al. Late throm- bosis in drug-eluting coronary stents after discontinuati- on of antiplatelet therapy. Lancet 2004;364:1519–21.
• Morice MC, Serruys PW, Sousa JE, et al. A randomi- zed comparison of a sirolimus-eluting stent with a stan- dard stent for coronary revascularization. N Engl J Med ;346:1773–80.
• Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxeleluting stent in patients with coronary artery disease. N Engl J Med 2004;350:221–31.
• Emmanouil S Brilakis, Subhash Banerjee,Peter Ber- ger.Perioperative managements of patients with coro- nary stents.JACC 2007,vol 49 no 22
• Finn AV, Kolodgie FD, Harnek J, et al. Differential response of delayed healing and persistent inflammati- on at sites of overlapping sirolimus-or paclitaxel-eluting stents. Circulation 2005;112:270 –8.
• Chu WW, Kuchulakanti PK, Torguson R, et al. Impact of overlapping drug-eluting stents in patients undergo- ing percutaneous coronary intervention. Catheter Car- diovasc Interv 2006;67:595–9.
• Kaluza GL, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol ;35:1288–94.
• Reddy PR, Vaitkus PT. Risks of noncardiac surgery after coronary stenting. Am J Cardiol 2005;95:755–7.
• Wilson SH, Fasseas P, Orford JL, et al. Clinical out- come of patients undergoing noncardiac surgery in the two months following coronary stenting. J Am Coll Car- diol 2003;42:234 –40.
• Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Reste- nosis Study Investigators. N Engl J Med 1998; :1665–71.
• Eisenstein EL, Anstrom KJ, Kong DF, et al. Clopi- dogrel use and long-term clinical outcomes after drug- eluting stent implantation. JAMA 2007;297:159 –68.
• Valerin M, Brennan M, Noll J, et al. Relationship bet- ween aspirin use and postoperative bleeding from den- tal extractions in a healthy population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:326.
• Kumar N, Jivan S, Thomas P, McLure H. Sub-Te- non’s anesthesia with aspirin, warfarin, and clopidogrel. J Cataract Refract Surg 2006;32:1022–5.
• Patterson L, Hunter D, Mann A. Appropriate waiting time for noncardiac surgery following coronary stent in- sertion: views of Canadian anesthesiologists. Can J Anaesth 2005;52:440–1.
• Berger PB, Bellot V, Bell MR, et al. An immediate in- vasive strategy for the treatment of acute myocardial in- farction early after noncardiac surgery. Am J Cardiol ;87:1100–2.