Inflammation and Perioperative Cardiovascular Events

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Immunology

Background:

• Surgery and anesthesia induce a stress response, leading to sympathetic stimulation, cortisol secretion, hypercoagulability, and systemic inflammation.
• These homeostatic changes, particularly systemic inflammation, elevate the risk of organ damage and perioperative cardiac complications, impacting both cardiovascular and non-cardiac surgeries.
• Preoperative inflammatory markers are linked to perioperative cardiovascular events, highlighting the role of inflammation in surgical risk.

Purpose of the Study:

• To explore the role of systemic inflammation in perioperative cardiac complications.
• To identify the utility of inflammatory biomarkers in predicting cardiovascular events.
• To discuss strategies for reducing perioperative inflammatory response and improving surgical outcomes.

Main Methods:

• Review of contemporary literature on surgical stress response and inflammation.
• Analysis of traditional (CRP, BNP) and novel biomarkers (galectin-3, TNF-α, MiRNAs) for predicting inflammatory response and cardiac injury.
• Discussion of methods to prevent and treat systemic inflammation perioperatively.

Main Results:

• Surgical procedures can trigger systemic inflammation, characterized by proinflammatory cytokine secretion, neutrophil activation, and tissue damage.
• Inflammatory biomarkers, including novel ones like galectin-3 and MiRNAs, can predict perioperative cardiac injury and cardiovascular events.
• Inflammatory markers increase post-surgery and typically decline within weeks, but elevated preoperative levels are significant predictors.

Conclusions:

• Determining inflammatory markers perioperatively can identify high-risk patients for cardiovascular events.
• Reducing perioperative inflammatory response is crucial for improving surgical outcomes.
• Optimizing surgical and anesthetic management, alongside pharmacological interventions like interleukin inhibitors, can mitigate systemic inflammation and enhance perioperative cardiac risk reduction strategies.