ABSTRACT
AIM: To determine current practice regarding the diabetes management of people undergoing cardiac surgery in the UK. METHODS: We conducted an online survey of UK cardiothoracic surgeons. All cardiothoracic surgeons listed in the Society of Cardiothoracic Surgery membership directory were invited to participate. The survey, compiled using SurveyMonkey software, comprised 15 closed and open-ended questions about the management of people with diabetes pre- and peri-operatively. RESULTS: Sixty-two cardiothoracic surgeons from all 33 UK cardiac centres completed the survey. Of these, 44% responded that they routinely measure HbA1c preoperatively for all patients, 19% had an HbA1c threshold above which they would not operate and 21% currently undertake a point-of-care HbA1c measurement during the cardiothoracic outpatient visit. A total of 74% of respondents reported that it was 'easy' or 'very easy' to obtain a diabetes team review; diabetes nurse specialists were the members of the diabetes team working most closely with cardiac surgeons. Up to a third of the surgeons did not provide physical activity recommendations prior to admission and over 80% did not have a different preoperative or surgical diabetes protocol. Inconsistency in the responses within centres suggests that differences in practice may depend on individual surgeons rather than local policy. CONCLUSIONS: The study demonstrates there is only limited peri-operative management of diabetes in people undergoing cardiac surgery in the UK. There is an opportunity for greater involvement of the diabetes specialist team both before and during admission for surgery to improve outcomes. (Trial registration: ISRCTN10170306).
Subject(s)
Cardiac Surgical Procedures , Diabetes Mellitus/therapy , Practice Patterns, Physicians'/statistics & numerical data , Adult , Aged , Aged, 80 and over , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/statistics & numerical data , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Diabetic Angiopathies/blood , Diabetic Angiopathies/epidemiology , Diabetic Angiopathies/surgery , Diabetic Angiopathies/therapy , Female , Glycated Hemoglobin/analysis , Glycated Hemoglobin/metabolism , Glycemic Control/methods , Glycemic Control/statistics & numerical data , Humans , Male , Middle Aged , Perioperative Care/methods , Perioperative Care/statistics & numerical data , Surgeons/statistics & numerical data , Surveys and Questionnaires , United Kingdom/epidemiologyABSTRACT
Bicuspid aortic valve (BAV) disease remains the most common congenital cardiac disease and is associated with an increased risk of potentially fatal aortopathy including aortic aneurysm and dissection. Mutations in the NOTCH1 gene are one of only a few genetic anomalies identified in BAV disease; however evidence for defective NOTCH signaling, and its involvement in the characteristic histological changes of VSMC apoptosis and differentiation in ascending aortae of BAV patients is lacking. This review scrutinizes the evidence for the interactions of NOTCH signaling, cellular differentiation and apoptosis in the context of aortic VSMCs and provides focus for future research efforts in the diagnosis of BAV aortopathy and prevention of catastrophic complications through NOTCH signaling manipulation.
Subject(s)
Aortic Diseases/metabolism , Aortic Valve/abnormalities , Apoptosis , Cell Differentiation , Heart Valve Diseases/metabolism , Muscle, Smooth, Vascular/metabolism , Myocytes, Smooth Muscle/metabolism , Receptor, Notch1/metabolism , Vasoconstriction , Animals , Aorta/metabolism , Aorta/pathology , Aorta/physiopathology , Aortic Diseases/genetics , Aortic Diseases/pathology , Aortic Diseases/physiopathology , Aortic Valve/metabolism , Aortic Valve/pathology , Aortic Valve/physiopathology , Bicuspid Aortic Valve Disease , Disease Progression , Genetic Predisposition to Disease , Heart Valve Diseases/genetics , Heart Valve Diseases/pathology , Heart Valve Diseases/physiopathology , Humans , Muscle, Smooth, Vascular/pathology , Muscle, Smooth, Vascular/physiopathology , Mutation , Myocytes, Smooth Muscle/pathology , Phenotype , Prognosis , Receptor, Notch1/genetics , Signal TransductionABSTRACT
OBJECTIVE: Carotid artery angioplasty and stenting (CAS) has been proposed as an alternative to surgery for patients with high-grade symptomatic carotid disease. The purpose of this study was to determine the proportion of patients that were suitable for each type of intervention and to analyse the reasons that precluded stenting. MATERIALS AND METHODS: This was a prospective observational study. All patients considered for intervention for carotid artery disease during an 18-month period were analysed. The management decision was recorded, as were the reasons for unsuitability for stenting. RESULTS: Two hundred and sixty-eight patients' data were analysed, 224 had complete records. Forty-seven patients did not require intervention and received best medical treatment alone. One hundred and seventy-seven patients required intervention, 113 were suitable for stenting and 64 were not. In 51 patients stenting was preferred. Sixty-two patients were suitable for either stent or surgery. Sixty-four patients were unsuitable for stenting. Carotid tortuosity and proximal disease accounted for 70% of this group. CONCLUSIONS: Current enthusiasm for carotid stenting might well be supported by the results of ongoing randomised-controlled clinical trials. However, this study highlights a significant proportion (64/177; 36%) of our patients is presently unsuitable for stenting. The common technical difficulties and limitations of stenting encountered in our unit are related predominantly to carotid anatomy.
