von Henrike Janßen ; Larissa Felgner ; Laura Kummer ; Hans-Jörg Gillmann ; Claudia Schrimpf ; Saad Rustum ; Ralf Lichtinghagen ; Bianca Sahlmann ; Markus A. Weigand ; Omke E. Teebken ; Gregor Theilmeier ; Jan Larmann
cardiac adverse event; Interleukin-6; Perioperative inflammation; Plaque vulnerability; regulatory T cells; Vascular Surgery
Patients at elevated cardiovascular risk are prone to perioperative cardiovascular complications, like myocardial injury after non-cardiac surgery (MINS). We have demonstrated in a mouse models of atherosclerosis that perioperative stress leads to an increase in plaque volume and higher plaque vulnerability. Regulatory T cells (Tregs) play a pivotal role in development and destabilization of atherosclerotic plaques. For this exploratory post-hoc analysis we identified 40 patients recruited into a prospective perioperative biomarker study, who within the inclusion period underwent sequential open vascular surgery. On the basis of protein markers measured in the biomarker study, we evaluated the perioperative inflammatory response in patients’ plasma before and after index surgery as well as before and after a second surgical procedurebefore and after both surgeries. We also analyzed available immunohistochemistry samples to describe plaque vulnerability in patients who underwent bilateral carotid endarterectomy (CEA) in two subsequent surgical procedures. Finally, we assessed if MINS was associated with sequential surgery. The inflammatory response of both surgeries was characterized by postoperative increases of interleukin-6, -10, and Pentraxin 3 and C-reactive protein with no clear-cut difference between different the two time points of both surgeryies. Plaques from CEA extracted during the second surgery contained less Tregs, as measured by Foxp3 staining, than plaques from the first intervention. Plaques from CEA extracted during the second surgery contained less regulatory T cells (Treg) compared to the plaques from the first intervention The 2nd surgical procedure was associated with MINS. In conclusion, we provide descriptive evidence that sequential surgical procedures involve repeat inflammation, and we hypothesize that elevated rates of cardiovascular complications after the second procedure could be related to reduced levels of intraplaque Tregs, a finding that deserves confirmatory testing and mechanistic exploration in future populations.In conclusion, we provide descriptive evidence that sequential surgical procedures are associated with inflammation, increased plaque vulnerability and higher rates of cardiovascular complications.
Frontiers in Cardiovascular Medicine Lausanne : Frontiers Media, 2014 7(2020) Artikel-Nummer 13, 11 Seiten Online-Ressource
Europe PMC is an archive of life sciences journal literature., Prospective evaluation of preoperative lung ultrasound for prediction of perioperative outcome and myocardial injury in adult patients undergoing vascular surgery (LUPPO study).
Minerva Anestesiologica Torino : Minerva Medica, 1998 86(2020), 11, Seite 1151-1160 Online-Ressource
First published January 23, 2017 ; Gesehen am 16.10.2018
Background:Patients undergoing vascular surgery are prone to perioperative organ injury because of both higher prevalence of cardiovascular risk factors and the extent of surgery. Early detection of organ failure is essential to facilitate appropriate medical care. Midregional pro-adrenomedullin (MR-proADM) has been investigated in acute medical care settings to guide clinical decision-making regarding patient pathways and to identify patients prone to imminent cardiovascular or inflammatory complications. In this study, we evaluated the impact of perioperative MR-proADM levels as an early marker of perioperative cardiovascular and inflammatory stress reactions and kidney injury.Methods:The study was conducted as a monocentric, prospective, noninterventional trial at Hannover Medical School, Germany. A total of 454 consecutive patients who underwent open vascular surgery were followed from the day prior to until 30 days after surgery. The composite primary end point was defined as the occurrence of major adverse cardiac events (MACEs), acute kidney injury (AKI), or systemic inflammatory response syndrome (SIRS). Measurements were correlated with both medical history and postoperative MACE, AKI, or SIRS using univariate and multivariate regression analysis.Results:One hundred thirty-nine (31%) of the patients reached the primary end point within the study interval. Midregional pro-adrenomedullin change was associated with the combined primary end point and with the intensity of surgical trauma. Midregional pro-adrenomedullin change was increased in patients reaching the secondary end points, SIRS (optimal cutoff: 0.2 nmol/L) and AKI (optimal cutoff: 0.7 nmol/L), but not in patients with MACEs.Conclusion:Increased levels of MR-proADM within the perioperative setting (1) were linked to the invasiveness of surgery and (2) identified patients with ongoing loss of renal function. Increased MR-proADM levels may therefore identify a subgroup of patients prone to excessive cardiovascular stress but did not directly correlate with adverse cardiac events. Consistently low levels of MR-proADM may identify a subgroup of patients with acceptable low risk to guide discharge from high-density care units.
Journal of intensive care medicine Thousand Oaks, Calif. [u.a.] : Sage Science Press, 1986 34(2019), 1, Seite 67-76 Online-Ressource
