Preoperative microvascular dysfunction: a prospective, observational study expanding risk assessment strategies in major thoracic surgery

The Annals of Thoracic Surgery
Robert SchierBernhard Riedel

Abstract

Brachial artery reactivity testing (BART)--a surrogate test of microvascular function--predicts cardiac risk in the nonsurgical population and associates it with adverse outcome after vascular surgery. This pilot study investigated BART-derived variables, including flow-mediated dilation (FMD), in preoperative risk stratification for major thoracic surgery. After institutional review board approval, BART was performed in 63 patients before major thoracic surgery. Ultrasonography recorded two-dimensional images and Doppler flow signals of the brachial artery preoperatively at baseline and after induced reactive hyperemia. Variables derived using BART were correlated with preoperative risk factors, established risk scores, and postoperative complications. The median preoperative FMD value in patients without postoperative complications was 11.5%. This value was used to delineate all patients into two groups: low (FMD < 11.5%) and high (FMD ≥ 11.5%) FMD cohorts. Patients in the low FMD group experienced more postoperative complications: 54% versus 30% had one or more adverse postoperative event, and 11% versus 0% had three or more adverse postoperative events (p < 0.001), respectively. The low FMD group required longer intensive c...Continue Reading

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Citations

Feb 27, 2013·The Annals of Thoracic Surgery·Robert Schier, Bernhard Riedel
Feb 27, 2013·The Annals of Thoracic Surgery·Mark Allen
Jun 28, 2012·The Annals of Thoracic Surgery·Mark Allen
Apr 26, 2014·Acta Clinica Belgica·M Raes, J Poelaert
May 31, 2017·Physiological Reports·Hans H DedichenIdar Kirkeby-Garstad
Aug 5, 2017·Circulation Journal : Official Journal of the Japanese Circulation Society·Yuichi SaitoYoshio Kobayashi
Dec 5, 2013·Current Opinion in Anaesthesiology·Bernhard RiedelBrendan Silbert

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