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The role of biomarkers in the preoperative evaluation of cardiac surgical patients – A narrative review 生物标志物在心脏手术患者术前评估中的作用——综述
IF 2.8 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.09.002
Giles Coverdale , Matthew Camilleri , Mathew Patteril
{"title":"The role of biomarkers in the preoperative evaluation of cardiac surgical patients – A narrative review","authors":"Giles Coverdale ,&nbsp;Matthew Camilleri ,&nbsp;Mathew Patteril","doi":"10.1016/j.bpa.2025.09.002","DOIUrl":"10.1016/j.bpa.2025.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Biomarkers play a crucial role in the preoperative assessment for cardiac surgery, aiding in risk stratification and evaluating comorbid diseases.</div></div><div><h3>Objective</h3><div>This narrative review summarizes current evidence on preoperative biomarkers in cardiac surgery and their role for risk stratification in international guidelines.</div></div><div><h3>Methods</h3><div>A review of relevant literature was conducted to assess the prognostic value of various biomarkers, including their integration into established risk scoring systems.</div></div><div><h3>Results</h3><div>Among cardiac biomarkers, brain natriuretic peptide (BNP) has been found to independently predict outcomes and may enhance prognostic accuracy when combined with scoring systems such as the Society of Thoracic Surgeons (STS) and Euroscore calculators. Additionally, several biomarkers related to comorbid diseases demonstrate independent associations with postoperative outcomes, some of which are already included in these scoring systems. Biomarkers such as glycosylated haemoglobin, C-reactive protein (CRP), and albumin levels are strongly linked to surgical outcomes and may aid perioperative optimization. Emerging evidence suggests that novel biomarkers, including inflammatory cytokines, may provide predictive value for specific complications.</div></div><div><h3>Conclusion</h3><div>Biomarkers are an essential component of preoperative assessment and risk stratification in cardiac surgery. Further research is needed to refine biomarker-based predictive models to enhance postoperative morbidity and mortality risk assessment.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 2","pages":"Pages 90-94"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of risk prediction scores in preoperative assessment of cardiac surgical patients 风险预测评分在心脏手术患者术前评估中的作用
IF 2.8 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.006
Kathirvel Subramaniam , Sennaraj Balasubramanian , Elissa Castor , Pooja Tallapaneni , Gautham Raghuthaman , Ibrahim Sultan
{"title":"Role of risk prediction scores in preoperative assessment of cardiac surgical patients","authors":"Kathirvel Subramaniam ,&nbsp;Sennaraj Balasubramanian ,&nbsp;Elissa Castor ,&nbsp;Pooja Tallapaneni ,&nbsp;Gautham Raghuthaman ,&nbsp;Ibrahim Sultan","doi":"10.1016/j.bpa.2025.08.006","DOIUrl":"10.1016/j.bpa.2025.08.006","url":null,"abstract":"<div><div>Preoperative risk prediction scores help to identify high risk patients, guide decision making on cardiac surgical procedures and also optimization before definitive surgery. The Society of Thoracic Surgeons large database-derived scoring system is utilized for this purpose in the United States. The STS risk score is not only useful in predicting mortality but also individual organ dysfunction after cardiac surgical procedures. Similarly, Euro SCORE is utilized in European countries to predict mortality after cardiac surgery. Apart from these two scoring systems, multiple organ specific complication scoring systems are being used to predict morbidity (e.g., atrial fibrillation score). Several frailty scoring systems are available to evaluate the risk of poor outcomes due to age-related decline in overall physiological reserve after surgery. In this article, we describe some of the commonly used risk prediction scores in cardiac surgery with their accuracy and drawbacks.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 2","pages":"Pages 83-89"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preoperative investigations and imaging for cardiac surgical patients 心脏手术患者的术前检查和影像学
IF 2.8 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.10.002
Sennaraj Balasubramanian , John Driggers , Alice Whyte , Kathirvel Subramaniam
{"title":"Preoperative investigations and imaging for cardiac surgical patients","authors":"Sennaraj Balasubramanian ,&nbsp;John Driggers ,&nbsp;Alice Whyte ,&nbsp;Kathirvel Subramaniam","doi":"10.1016/j.bpa.2025.10.002","DOIUrl":"10.1016/j.bpa.2025.10.002","url":null,"abstract":"<div><div>Cardiac surgery poses several unique challenges for perioperative physicians and surgeons, and thorough preoperative assessment and investigation are imperative. Meticulous preoperative assessment and investigations allow selection of appropriate surgical procedures, identification of patients at high risk of perioperative complications, and crafting individualized perioperative care plans for these patients. Our review describes many facets of pre-operative investigations for patients undergoing cardiac surgery, highlighting their importance and limitations.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 2","pages":"Pages 74-82"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preoperative pulmonary optimization and risk mitigation 术前肺优化和风险降低
IF 2.8 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.009
Evan Derector , Jennifer Varallo , Wissam Abouzgheib , Talia K. Ben-Jacob
{"title":"Preoperative pulmonary optimization and risk mitigation","authors":"Evan Derector ,&nbsp;Jennifer Varallo ,&nbsp;Wissam Abouzgheib ,&nbsp;Talia K. Ben-Jacob","doi":"10.1016/j.bpa.2025.08.009","DOIUrl":"10.1016/j.bpa.2025.08.009","url":null,"abstract":"<div><div>Optimization of pulmonary health and risk mitigation is a critical component of preoperative preparation for cardiac surgery, impacting both short- and long-term postoperative outcomes. A wide array of tests and interventions have been studied such as pulmonary function testing, pulmonary risk stratification, and prehabilitation therapies. While each intervention has its utility, there lacks consensus on pulmonary evaluation and optimization prior to cardiac surgery. Special consideration should be given to the preoperative management and treatment of underlying comorbid pulmonary conditions that frequently impact postoperative outcomes. Targeted approaches have demonstrated potential to mitigate the risks associated with these conditions and improve surgical outcomes. This review aims to summarize recommended preoperative pulmonary evaluation and prehabilitation protocols, and discuss targeted approaches for patient-specific comorbidities to optimize patients and reduce postoperative complications in cardiac surgery.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 2","pages":"Pages 119-127"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Brain health measures and prehabilitation in cardiac surgery 心脏手术中的脑健康措施和康复
IF 2.8 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.09.001
Ludmil Mitrev , Adam S. Mangold , Stefano Benincasa
{"title":"Brain health measures and prehabilitation in cardiac surgery","authors":"Ludmil Mitrev ,&nbsp;Adam S. Mangold ,&nbsp;Stefano Benincasa","doi":"10.1016/j.bpa.2025.09.001","DOIUrl":"10.1016/j.bpa.2025.09.001","url":null,"abstract":"<div><div>Prehabilitation is the optimization of patients prior to surgery to improve postoperative outcomes. Postoperative neurological complications, including stroke, delirium, and postoperative cognitive decline, are commonly reported in patients undergoing cardiac surgery. To risk-stratify and optimize patients prior to cardiac surgery with respect to these complications, various measures of preoperative brain health are utilized in prehabilitation regimens. In this narrative review, we summarize the markers and assessments of brain health that are used to evaluate preoperative brain function, as well as the prehabilitation measures that have shown favorable association with reduction of postoperative neurologic complications. This includes an overview of serum biomarkers, physical therapies, cognitive training, nutritional supplementation, and substance use cessation counseling that are available during cardiac prehabilitation. Neurocognitive outcomes of patients who underwent prehabilitation prior to cardiac surgery are reported. Substance use cessation prior to cardiac surgery is discussed.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 2","pages":"Pages 128-137"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preoperative evaluation and prehabilitation for cardiac surgical patients: Managing medications pre-procedure to optimize patient outcomes 心脏手术患者的术前评估和康复：术前药物管理以优化患者预后
IF 2.8 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.007
Marie Caruso , Alyssa Exarchakis , Anika Pruthi , Erin Pukenas
{"title":"Preoperative evaluation and prehabilitation for cardiac surgical patients: Managing medications pre-procedure to optimize patient outcomes","authors":"Marie Caruso ,&nbsp;Alyssa Exarchakis ,&nbsp;Anika Pruthi ,&nbsp;Erin Pukenas","doi":"10.1016/j.bpa.2025.08.007","DOIUrl":"10.1016/j.bpa.2025.08.007","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 2","pages":"Pages 109-118"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cardiac prehabilitation: Is there a role in cardiac surgery 心脏康复：在心脏外科手术中有作用吗
IF 2.8 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.008
Chiara Di Giambattista, Katelijne Buyck, Stephen Shepherd
{"title":"Cardiac prehabilitation: Is there a role in cardiac surgery","authors":"Chiara Di Giambattista,&nbsp;Katelijne Buyck,&nbsp;Stephen Shepherd","doi":"10.1016/j.bpa.2025.08.008","DOIUrl":"10.1016/j.bpa.2025.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac surgery presents significant perioperative risks, particularly for high-risk populations such as elderly and frail patients. Prehabilitation, a preoperative strategy focusing on patient optimization, has emerged as a promising intervention to enhance recovery and reduce complications.</div></div><div><h3>Objectives</h3><div>This review explores the evidence supporting prehabilitation programs, which integrate exercise, nutritional optimization, psychological support, and patient education to improve cardiac surgical outcomes.</div></div><div><h3>Methods</h3><div>A review of current literature highlights the benefits, challenges, and emerging multidisciplinary approaches in cardiac prehabilitation, including inspiratory muscle training and tailored nutritional support.</div></div><div><h3>Results</h3><div>While prehabilitation is well-established in other surgical specialties, its implementation in cardiac surgery remains limited due to protocol heterogeneity, time constraints, and patient-specific factors. Early data suggest improved recovery, reduced hospital stays, and better perioperative outcomes.</div></div><div><h3>Conclusions</h3><div>Standardized prehabilitation protocols and additional research are necessary to improve patient selection, increase adherence, and assess long-term effects. With around one million cardiac surgeries conducted worldwide annually, incorporating structured prehabilitation programs may enhance patient outcomes and refine perioperative care.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 2","pages":"Pages 147-156"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prehabilitation and enhanced recovery after cardiac surgery 心脏手术后的预适应和增强恢复
IF 2.8 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.002
Benjamin Shuker, Kathryn Essak, Mathew Patteril
{"title":"Prehabilitation and enhanced recovery after cardiac surgery","authors":"Benjamin Shuker,&nbsp;Kathryn Essak,&nbsp;Mathew Patteril","doi":"10.1016/j.bpa.2025.08.002","DOIUrl":"10.1016/j.bpa.2025.08.002","url":null,"abstract":"<div><div>Cardiac surgery carries substantial risks, particularly for an aging population with increased frailty, morbidity, and malnutrition. Prehabilitation and Enhanced Recovery After Surgery (ERAS) protocols are emerging as essential strategies to optimize patients before surgery and accelerate postoperative recovery. In this review, we explore the role of prehabilitation and ERAS protocols in cardiac surgery, identify the challenges in implementing these strategies, and highlight areas for future research. Prehabilitation involves structured interventions such as physical conditioning, respiratory training, nutritional optimization, psychological support, and lifestyle modifications. While prehabilitation's role in non-cardiac surgery is well-established, its application in cardiac surgery remains less defined due to a lack of high-quality trial data and variability in studies. ERAS protocols, initially designed for colorectal surgery, have been adapted for cardiac surgery to include patient education, early mobilization, multimodal analgesia, and blood conservation techniques. Despite promising evidence regarding prehabilitation and ERAS protocols, the widespread adoption in cardiac surgery has been hindered by patient heterogeneity, limited access, and logistical constraints. The potential benefits include reduced complications, shorter hospital stays, improved recovery, and better patient outcomes. Future research should focus on standardizing prehabilitation protocols, assessing their impact on high-risk populations, and exploring telemedicine solutions to enhance accessibility.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 2","pages":"Pages 157-165"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reimagining cardiac surgery—the emerging role of prehabilitation and risk optimization 重新想象心脏手术——康复和风险优化的新角色
IF 2.8 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.005
Ludmil V. Mitrev , Kathirvel Subramaniam , Mathew Patteril
{"title":"Reimagining cardiac surgery—the emerging role of prehabilitation and risk optimization","authors":"Ludmil V. Mitrev ,&nbsp;Kathirvel Subramaniam ,&nbsp;Mathew Patteril","doi":"10.1016/j.bpa.2025.08.005","DOIUrl":"10.1016/j.bpa.2025.08.005","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 2","pages":"Pages 71-73"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Obesity and the surgical heart: Challenges, strategies, and innovations 肥胖和心脏手术：挑战、策略和创新
IF 2.8 3区 医学
Best Practice & Research-Clinical Anaesthesiology Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.004
Roshni Cheema , David Kratzenberg , Pranav Doshi , Kathirvel Subramaniam
{"title":"Obesity and the surgical heart: Challenges, strategies, and innovations","authors":"Roshni Cheema ,&nbsp;David Kratzenberg ,&nbsp;Pranav Doshi ,&nbsp;Kathirvel Subramaniam","doi":"10.1016/j.bpa.2025.08.004","DOIUrl":"10.1016/j.bpa.2025.08.004","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 2","pages":"Pages 95-102"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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