Reducing the Risk of Cardiac Ischemia in Older TJA Patients

    Certain older patients undergoing elective total hip or total knee arthroplasty are at greater risk than others for experiencing myocardial damage during surgery. What can be done to reduce that risk?

    To find out, Hossam El Beheiry, MBBCh, MSc, PhD, FRCPC, and his colleagues from the Department of Anesthesia at the University of Toronto evaluated 50 patients age 65 or older who were scheduled for elective athroplasty and were at risk for perioperative ischemia, defined as having 3 or more of the predictors of ischemia based on Lee’s Revised Cardiac Risk Index:

    • High-risk surgical procedure
    • History of ischemic heart disease
    • History of congestive heart failure
    • History of cerebrovascular disease
    • Preoperative treatment with insulin
    • Preoperative serum creatinine > 2.0 mg/dL (177 µmol/l)

    Their goal was to determine the incidence of elevated postoperative troponin-I (cTn-I) levels – an indicator of myocardial damage – and associated risk factors in this patient population. They evaluated cTn-I levels and 12-lead ECG results for 3 days after surgery and performed linical examinations until discharge.

    The researchers found a low incidence, about 8%, of elevated cTn-I in these patients, which was associated with general anesthesia and increased postoperative serum creatinine level. Patients who had elevated cTn-1 levels were asymptomatic, and most didn’t have ECG changes. A 30-day and 1-year follow-up did not show any morbidity or mortality.

    Dr. El Beheiry, who presented the study results at the annual meeting of the American Society of Anesthesiologists, told ICJR that he and his colleagues concluded that myocardial damage in older patients undergoing joint replacement surgery may be prevented by using neuraxial blockade instead of general anesthesia, as well as ensuring adequate renal protection.

    Click the image above to hear his comments about the study.

    Producer: Susan Doan-Johnson; Director: Michael Bugera; Post Production: Charles J. Maynard


    Beheiry HE, Weinberg A, Getahun T. General anesthesia and increased postoperative creatinine are associated with postoperative elevation of tropnin-i in elderly patients with high cardiac risk index undergoing large joint replacement. Presented at ANESTHESIOLOGY 2015, Annual Meeting of the American Society of Anesthesiologists, October 24-28, 2015, San Diego, California. Abstract A2016.