Rubén DÃaz Jure2011-05-12
Non-Cardiac Surgery After TAVR Is Safe
There are increasingly more patients who have undergone transcatheter aortic valve replacement (TAVR) and require a non-cardiac intervention, or patients with other diseases who need surgery and are diagnosed with aortic stenosis. In addition, on many occasions, surgery must be performed as soon as possible (as in cases of cancer) or is an emergency procedure....
ACC 2022 – POISE-3: Tranexamic Acid, Bleeding and Cardiovascular Events in Non-Cardiac Surgeries
Tranexamic Acid is an antifibrinolytic which has been shown to reduce bleeding in orthopedic patients and cardiac surgery. But evidence for its use in non-cardiac surgery is still limited. The aim of this study was to assess whether tranexamic acid reduces the incidence of bleeding events, which include life threatening bleeding, major bleeding, or bleeding...
More Screening Needed Before Non-Cardiac Surgery
According to this recent document by the American Heart Association (AHA), troponin should be monitored for at least 3 days after surgery. With about 20% of patients (most of them, asymptomatic) showing elevated troponin after a non-cardiac surgery, this new AHA document recommends monitoring, for at least two days, patients with moderate to severe ischemia. Myocardial...
How to Discontinue Antiplatelet Therapy Prior Non-Cardiac Surgery
Both the indication and discontinuation of antiplatelet therapy to balance ischemic-bleeding risks has been left to physician criterion. However, leaving the decision to one single specialist might not be the best. This is when the team’s role becomes essential. This study looked at the advantages consensus decision-making amongst clinicians, surgeons and anesthesiologists to continue or...
Restenosis Does Not Seem as Benign as We Thought
Elective, uncomplicated repeat revascularization after stent restenosis is associated with higher mortality rates according to a new meta-analysis that will be published soon in J Am Coll Cardiol Intrv. Historically, interventional cardiologists have seen target lesion revascularization (TLR) as a procedure that “unjustly” increased combined events in clinical studies and our own databases, thus representing...
Aspirin During Noncardiac Surgery: Only in Patients with Prior Angioplasty
A new analysis from the POISE-2 study suggests that aspirin should not be withheld prior to noncardiac surgery in patients with a history of coronary angioplasty, even if their coronary procedure occurred several years earlier. Patients with a history of coronary angioplasty who need cardiac surgery are more likely to benefit from continued aspirin therapy,...
TRICS III: Restrictive Transfusion Was Noninferior to Liberal Use in Patients Who Undergo Cardiac Surgery
A large study conducted in 19 countries has found that a policy of restrictive red-cell transfusion during cardiac surgery is just as safe and effective as more liberal policies. TRICS III enrolled 5243 patients and was presented at the American Heart Association (AHA) Scientific Sessions and published simultaneously in the New England Journal of Medicine (NEJM). Patients were...
Hybrid Revascularization or Conventional Surgery: History Is Still Being Written
Hybrid revascularization seems to achieve results similar to those of conventional myocardial revascularization surgery at 5 years, although studies published so far do not seem to be enough for a definitive answer. This new work, soon to be published in J Am Coll Cardiol Intv, has had promising results in selected patients with multivessel disease; however,...
Is Emergency Cardiac Surgery Necessary in TAVR?
Life-threatening complications that require surgery during TAVR are infrequent. The proportion was originally thought to be between 1% and 2%. However, we now know that it is lower, even though we do not know how frequent it is or what are its most common causes. Its evolution, both in the short and in the long...