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Perioperative medical therapy in adult patients undergoing cardiac surgery

Authors: Berdibekov B.Sh., Bulaeva N.I., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2023-17-1-34-49

For citation: Berdibekov B.Sh., Bulaeva N.I., Golukhova E.Z. Perioperative medical therapy in adult patients undergoing cardiac surgery. Creative Cardiology. 2023; 17 (1): 34–49 (in Russ.). DOI: 10.24022/1997-3187-2023-17-1-34-49

Received / Accepted:  17.01.2023 / 29.03.2023

Keywords: medical therapy perioperative period cardiac surgery adult patients

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Abstract

Adult cardiac surgery is an essential approach to reducing mortality and morbidity in appropriately defined patients. The outcome depends on the management of underlying conditions, and medical treatment is key to the optimal perioperative and long-term success of cardiac surgery. Medical therapy of adult patients undergoing cardiac surgery has features at each stage of the perioperative period. In the preoperative period, initiation or discontinuation of medication may be required to reduce the likelihood of intra- and postoperative complications. Intra- and postoperative glycemic control and prophylactic antibiotic therapy are necessary to reduce the risk of infectious complications. In the postoperative period, resumption or the initiation of medication is also necessary for the prevention of ischemic events, prophylaxis of arrhythmias, and control of cardiovascular risk factors, which are necessary components for a positive impact on both early and long-term prognosis. The options for perioperative medical therapy depend on the specific disease, coexisting conditions, type of surgery, and course of the postoperative period. This article provides an overview of current recommendations on some issues of perioperative introduction of patients undergoing cardiac surgery.

References

  1. Sousa-Uva M., Head S.J., Milojevic M., Collet J.P., Landoni G., Castella M. et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur. J. Cardiothorac. Surg. 2018; 53 (1): 5–33. DOI: 10.1093/ejcts/ezx314
  2. Valgimigli M., Bueno H., Byrne R.A., Collet J.P., Costa F., Jeppsson A. et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur. J. Cardiothorac. Surg. 2018; 53 (1): 34–78. DOI: 10.1093/ejcts/ezx334
  3. Dunning J., Versteegh M., Fabbri A., Pavie A., Kolh P., Lockowandt U. et al. EACTS Audit and Guidelines Committee. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur. J. Cardiothorac. Surg. 2008; 34 (1): 73–92. DOI: 10.1016/j.ejcts.2008.02.024
  4. Hansson E.C., Shams Hakimi C., Aström-Olsson K., Hesse C., Wallén H., Dellborg M. et al. Effects of ex vivo platelet supplementation on platelet aggregability in blood samples from patients treated with acetylsalicylic acid, clopido46 Creative Cardiology. 2023; 17 (1) DOI: 10.24022/1997-3187-2023-17-1-34-49
  5. Nenna A., Spadaccio C., Prestipino F., Lusini M., Sutherland F.W., Beattie G.W. et al. Effect of preoperative aspirin replacement with enoxaparin in patients undergoing primary isolated on-pump coronary artery bypass grafting. Am. J. Cardiol. 2016; 117 (4): 563–70. DOI: 10.1016/j.amjcard. 2015.11.040
  6. Mangano D.T.; Multicenter Study of Perioperative Ischemia Research Group. Aspirin and mortality from coronary bypass surgery. N. Engl. J. Med. 2002; 347 (17): 1309–17. DOI: 10.1056/NEJMoa020798
  7. Musleh G., Dunning J. Does aspirin 6 h after coronary artery bypass grafting optimise graft patency? Interact. Cardiovasc. Thorac. Surg. 2003; 2 (4): 413–5. DOI: 10.1016/S1569-9293 (03)00181-6
  8. Angiolillo D.J., Firstenberg M.S., Price M.J., Tummala P.E., Hutyra M., Welsby I.J. et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. JAMA. 2012; 307 (3): 265–74. DOI: 10.1001/jama.2011.2002
  9. Neumann F.J., Sousa-Uva M., Ahlsson A., Alfonso F., Banning A.P., Benedetto U. et al. ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2019; 40 (2): 87–165. DOI: 10.1093/eurheartj/ehy394
  10. Kulik A., Ruel M., Jneid H., Ferguson T.B., Hiratzka L.F., Ikonomidis J.S. et al. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association. Circulation. 2015; 131 (10): 927–64. DOI: 10.1161/CIR.0000000000000182
  11. Vahanian A., Beyersdorf F., Praz F., Milojevic M., Baldus S., Bauersachs J. et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur. Heart J. 2022; 43 (7): 561–632. DOI: 10.1093/eurheartj/ehab395
  12. Douketis J.D., Spyropoulos A.C., Kaatz S., Becker R.C., Caprini J.A., Dunn A.S. et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N. Engl. J. Med. 2015; 373 (9): 823–33. DOI: 10.1056/NEJMoa1501035
  13. Eikelboom J.W., Connolly S.J., Brueckmann M., Granger C.B., Kappetein A.P., Mack M.J. et al. Dabigatran versus warfarin in patients with mechanical heart valves. N. Engl. J. Med. 2013; 369 (13): 1206–14. DOI: 10.1056/NEJMoa1300615
  14. Jawitz O.K., Wang T.Y., Lopes R.D., Chavez A., Boyer B., Kim H. et al. Rationale and design of PROACT Xa: a randomized, multicenter, open-label, clinical trial to evaluate the efficacy and safety of apixaban versus warfarin in patients with a mechanical On-X Aortic Heart Valve. Am. Heart J. 2020; 227: 91–9. DOI: 10.1016/j.ahj. 2020.06.014
  15. Golukhova E.Z., Berdibekov B.Sh., Ruzina E.V. Efficacy and safety of combined aspirin and warfarin therapy after heart valve replacement: a systematic review and meta-analysis of randomized clinical trials. Russian Journal of Cardiology. 2022; 27 (3S): 4933 (in Russ.). DOI: 10.15829/1560- 4071-2022-4933
  16. Dewilde W.J., Oirbans T., Verheugt F.W., Kelder J.C., De Smet B.J., Herrman J.P. et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013; 381 (9872): 1107–15. DOI: 10.1016/S0140-6736 (12) 62177-1
  17. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021; 42 (5): 373–498. DOI: 10.1093/eurheartj/ehaa612
  18. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2021; 42 (36): 3599–726. DOI: 10.1093/eurheartj/ehab368
  19. Rouleau J.L, Warnica W.J, Baillot R., Block P.J., Chocron S., Johnstone D. et al. Effects of angiotensin-converting enzyme inhibition in lowrisk patients early after coronary artery bypass surgery. Circulation. 2008; 117 (1): 24–31. DOI: 10.1161/CIRCULATIONAHA.106.685073
  20. Blessberger H., Kammler J., Steinwender C. Perioperative use of β-blockers in cardiac and noncardiac surgery. JAMA. 2015; 313 (20): 2070–1. DOI: 10.1001/jama.2015.1883
  21. Dunning J., Treasure T., Versteegh M., Nashef S.A.; EACTS Audit and Guidelines Committee. Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery. Eur. J. Cardiothorac. Surg. 2006; 30 (6): 852–72. DOI: 10.1016/j.ejcts.2006.09.003
  22. Lin T., Hasaniya N.W., Krider S., Razzouk A., Wang N., Chiong J.R. Mortality reduction with beta-blockers in ischemic cardiomyopathy patients undergoing coronary artery bypass grafting. Congest. Heart Fail. 2010; 16 (4): 170–4. DOI: 10.1111/j.1751-7133.2010.00146.x
  23. Zheng Z., Jayaram R., Jiang L., Emberson J., Zhao Y., Li Q. et al. Perioperative rosuvastatin in Cardiac Surgery. N. Engl. J. Med. 2016; 374 (18): 1744–53. DOI: 10.1056/NEJMoa1507750
  24. Billings F.T., Hendricks P.A., Schildcrout J.S., Shi Y., Petracek M.R., Byrne J.G. et al. High-dose perioperative atorvastatin and acute kidney injury following cardiac surgery: a randomized clinical trial. JAMA. 2016; 315 (9): 877–88. DOI: 10.1001/jama.2016.0548
  25. Mach F., Baigent C., Catapano A.L., Koskinas K.C., Casula M., Badimon L. et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur. Heart J. 2020; 41 (1): 111–88. DOI: 10.1093/eurheartj/ehz455
  26. Shah S.J., Waters D.D., Barter P., Kastelein J.J., Shepherd J., Wenger N.K. et al. Intensive lipidlowering with atorvastatin for secondary prevention in patients after coronary artery bypass surgery. J. Am. Coll. Cardiol. 2008; 51 (20): 1938–43. DOI: 10.1016/j.jacc.2007.12.054
  27. Eisen A., Cannon C.P., Blazing M.A., Bohula E.A., Park J.G., Murphy S.A. et al. The benefit of adding ezetimibe to statin therapy in patients with prior coronary artery bypass graft surgery and acute coronary syndrome in the IMPROVE-IT trial. Eur. Heart J. 2016; 37 (48): 3576–84. DOI: 10.1093/eurheartj/ehw377
  28. Sabatine M.S., Giugliano R.P., Keech A.C., Honarpour N., Wiviott S.D. et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N. Engl. J. Med. 2017; 376 (18): 1713–22. DOI: 10.1056/NEJMoa1615664 29. Filsoufi F., Rahmanian P.B., Castillo J.G, Scurlock C., Legnani P.E., Adams D.H. Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery. Ann. Surg. 2007; 246 (2): 323–9. DOI: 10.1097/SLA. 0b013e3180603010
  29. Hata M., Shiono M., Sekino H., Furukawa H., Sezai A., Iida M. et al. Prospective randomized trial for optimal prophylactic treatment of the upper gastrointestinal complications after open heart surgery. Circ. J. 2005; 69 (3): 331–4. DOI: 10.1253/circj.69.331
  30. Whitlock R.P., Chan S., Devereaux P.J., Sun J., Rubens F.D., Thorlund K. et al. Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials. Eur. Heart J. 2008; 29 (21): 2592–600. DOI: 10.1093/eurheartj/ehn333
  31. Whitlock R.P., Devereaux P.J., Teoh K.H., Lamy A., Vincent J., Pogue J. et al. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial. Lancet. 2015; 386 (10000): 1243–53. DOI: 10.1016/S0140-6736 (15)00273-1
  32. Dieleman J.M., Nierich A.P., Rosseel P.M., van der Maaten J.M., Hofland J., Diephuis J.C. et al. Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial. JAMA. 2012; 308 (17): 1761–7. DOI: 10.1001/jama.2012.14144
  33. Chou R., Gordon D.B., de Leon-Casasola O.A., Rosenberg J.M., Bickler S., Brennan T. et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J. Pain. 2016; 17 (2): 131–57. DOI: 10.1016/j.jpain.2015.12.008
  34. Jelacic S., Bollag L., Bowdle A., Rivat C., Cain K.C., Richebe P. Intravenous acetaminophen as an adjunct analgesic in cardiac surgery reduces opioid consumption but not opioid-related adverse effects: a randomized controlled trial. J. Cardiothorac. Vasc. Anesth. 2016; 30 (4): 997–1004. DOI: 10.1053/j.jvca.2016.02.010
  35. Kulik A., Bykov K., Choudhry N.K., Bateman B.T. Non-steroidal anti-inflammatory drug administration after coronary artery bypass surgery: utilization persists despite the boxed warning. Pharmacoepidemiol. Drug. Saf. 2015; 24 (6): 647–53. DOI: 10.1002/pds.3788
  36. Schjerning Olsen A.M., Fosbo/l E.L., Lindhardsen J., Folke F., Charlot M. et al. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Circulation. 2011; 123 (20): 2226–35. DOI: 10.1161/CIRCULATIONAHA.110.004671
  37. Qazi S.M., Sindby E.J., No/rgaard M.A. Ibuprofen – a safe analgesic during cardiac surgery recovery? A randomized controlled trial. J. Cardiovasc. Thorac. Res. 2015; 7 (4): 141–8. DOI: 10.15171/jcvtr.2015.31
  38. Ott E., Nussmeier N.A., Duke P.C., Feneck R.O., Alston R.P., Snabes M.C. et al. Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib in patients undergoing coronary artery bypass surgery. J. Thorac. Cardiovasc. Surg. 2003; 125 (6): 1481–92. DOI: 10.1016/s0022-5223(03)00125-9
  39. Nussmeier N.A., Whelton A.A., Brown M.T., Langford R.M., Hoeft A., Parlow J.L. et al. Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. N. Engl. J. Med. 2005; 352 (11): 1081–91. DOI: 10.1056/NEJMoa050330
  40. Lazar H.L., McDonnell M., Chipkin S.R., Furnary A.P., Engelman R.M., Sadhu A.R. et al. Society of Thoracic Surgeons Blood Glucose Guideline Task Force. The Society of Thoracic Surgeons practice guideline series: blood glucose management during adult cardiac surgery. Ann. Thorac. Surg. 2009; 87 (2): 663–9. DOI: 10.1016/j.athoracsur.2008.11.011
  41. Ascione R., Rogers C.A., Rajakaruna C., Angelini G.D. Inadequate blood glucose control is associated with in-hospital mortality and morbidity in diabetic and nondiabetic patients undergoing cardiac surgery. Circulation. 2008; 118 (2): 113–23. DOI: 10.1161/CIRCULATIONAHA.107.706416
  42. Preiser J.C., Straaten H.M. Glycemic control: please agree to disagree. Intensive Care Med. 2016; 42 (9): 1482–4. DOI: 10.1007/s00134-016-4374-8
  43. Umpierrez G., Cardona S., Pasquel F., Jacobs S., Peng L., Unigwe M. et al. Randomized controlled trial of intensive versus conservative glucose control in patients undergoing coronary artery bypass graft surgery: GLUCO-CABG Trial. Diabetes Care. 2015; 38 (9): 1665–72. DOI: 10.2337/dc15-0303
  44. NICE-SUGAR Study Investigators; Finfer S., Chittock D.R., Su S.Y., Blair D., Foster D. et al. Intensive versus conventional glucose control in critically ill patients. N. Engl. J. Med. 2009; 360 (13): 1283–97. DOI: 10.1056/NEJMoa0810625

About Authors

  • Bektur Sh. Berdibekov, Junior Researcher, Cardoilogist; ORCID
  • Naida I. Bulaeva, Cand. Biol. Sci., Senior Researcher, Cardiologist, Head of Department; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of Russian Academy of Sciences, Director; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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