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Surgical Management in Patients with Cardiovascular Complications:

Exemplary Introduction Section of your Literature Review

Dr. Nancy Agens, Head,

Technical Operations, Pubrica

sales@pubrica.com

I. INTRODUCTION

Surgical management of disease has a

tremendous impact on our health

system.Despite increasingly sophisticated

management during the period of a

patient's surgical procedure; cardiovascular

complications continue to be major

challenges for the clinician. As a growing

number of elderly patients with known

coronary artery disease (CAD) or with risk

factors for CAD are undergoing non-

cardiac surgery, cardiovascular

complications will remain a significant

clinical problem in the future. The number

says approximately 100 million adults

undergo non-cardiac surgery worldwide

yearly 1

and up to 40% of these patients

have or are at risk of coronary artery

disease (CAD) 2

. Four million patients per

year have been sketched to have a major

perioperative cardiovascular complication,

including cardiac death, non-fatal

myocardial infarction or cardiac arrest 1

. In

high-risk patients, the incidence of major

perioperative cardiac complications varies

from 4 to 25 % depending on patient

population and type of surgery 3-5

.

Medical research studies have

shown that15-25% 6-9

of in-hospital

mortality occurs due to perioperative

myocardial infarction (PMI). The absence

of primary symptoms in the perioperative

period leads to the difficulty to detect PMI

may be the major reason for these high

mortality rates 10

. It was reported that

hardly only 14% of the patients with a

PMI have typical chest pain and

consequently 53% of the PMI will not be

diagnosed if the physician relies only on

symptoms or clinical signs 11

.

Therefore,for detecting

perioperative myocardial damage cardiac

markers primarily called the cardiac-

specific troponins are vital[Importance of

the study]. Though, the appropriate cut-

off levels for detecting myocardial damage

using troponins in a surgical setting are

debated. Elevated troponin with or without

clinical or ECG signs of ischaemia are

known to be associated with poor outcome

both in patients with acute coronary

syndrome12

as well as patients undergoing

non-cardiac surgery13, 14

.[Introduction to

the review] This systematic review will

provide information and recommendations

based on current guidelines related to

perioperative evaluation and management

including perioperative cardiac risk

evaluation and assessment of functional

capacity, role of ancillary preoperative

cardiac evaluation, recommendations

related to perioperative medical therapy,

perioperative cardiac intervention

including management of patients with

prior coronary intervention, perioperative

anticoagulant therapy, intraoperative

monitoring, and postoperative evaluation

and management.

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