Extract
Cardiac patients commonly have a number of co-morbidities. Some of them may require non-cardiac surgery. The peri-operative risk of such patients is markedly increased not only due to the cardiac condition itself and co-morbidities associated with it, but—particularly in the emergency situation—also due to the medication they take.1 Obviously, antiplatelet2 and antithrombotic drugs3 increase the risk of bleeding, which is challenging to manage.4 Furthermore, neurohumoral blockers may interfere with the ability of the circulation to cope with changes in blood volume and pressure. Finally, cardiac patients undergo bypass and valvular surgery which poses a risk to the ischaemic myocardium. The latter issue is addressed in an ESC Report of this Focus Issue on peri-operative care entitled ‘ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper:peri-operative myocardial injury and infarction in patients undergoingcoronary artery bypasssurgery’.5 Bypass surgery is still a very common procedure as coronary artery disease is one of the leading causes of death and disability,6 and not all patients are suitable for percutaneous interventions, particularly those with multivessel coronary artery disease and diabetes.7 Due to our ageing population, an increased prevalence of co-morbidities such as diabetes, hypertension, obesity, and renal failure, as well as a growing need for concomitant valve and aortic surgery, higher risk patients are undergoing the procedure. As a consequence, the risk of peri-operative myocardial injury and type 5 myocardial infarction increases, both of which are associated with poor post-operative outcomes. As such, novel therapies to protect the heart from peri-operative myocardial injury and type 5 myocardial infarction are an unmet need. There is currently no clear definition for clinically relevant peri-operative myocardial injury. Furthermore, there is no guidance on how to manage such patients. Therefore, the ESC Joint Working Groups Position Paper tries to provide a set of recommendations to: (i) define clinically relevant peri-operative myocardial injury and type 5 myocardial infarction and (ii) provide guidance on the management of peri-operative myocardial injury and type 5 myocardial infarction following coronary artery bypass graft surgery.
