Downloaded from http://heart.bmj.com/ on March 15, 2015 - Published by group.bmj.com
PostScript To cite Luciani GB. Heart 2014;100:1987–1988.
▸ http://dx.doi.org/10.1136/heartjnl-2014-306767 Heart 2014;100:1987–1988. doi:10.1136/heartjnl-2014-307080
REFERENCES 1
2
3
4
5
6
Luciani GB, Lucchese G, Carotti A, et al. Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry. Heart 2014;100:1954–9. Ma K, Chen Q, Li S. The role of LV in the autograft complication after ROSS operation. Heart 2014;100:1988. Hazekamp MG, Grotenhuis HB, Schoof PH, et al. Results of the Ross operation in a pediatric population. Eur J Cardiothorac Surg 2005;27: 975–9. Luciani GB, Favaro A, Casali G, et al. Ross operation in the young: a ten-year experience. Ann Thorac Surg 2005;80:2271–7. Horer J, Kasnar-Samprec J, Charitos E, et al. Patient age at the Ross operation in children influences aortic root dimensions and aortic regurgitation. World J Pediatr Congenit Heart Surg 2013;4: 245–2. Luciani GB, Lucchese G, Carotti A, et al. Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry. Heart 2014;100:1954–9.
Re: Preprocedural fasting for coronary interventions: is it time to change practice? The Authors’ reply: We read with interest the comments from Wijeyeratne et al1 regarding our paper. They commend our study2 for questioning the need for fasting prior to percutaneous cardiac procedures and highlight the lack of evidence either for or against the necessity to fast in this scenario. We agree with their comments and fully accept the limitations of our retrospectively analysed data. While we do not expect our paper to result in an immediate major practice shift in cardiology, we certainly hope that it will raise awareness of this issue.
1988
As they point out, patients might be instructed to fast, drink fluids only or not fast at all (for varying periods of time) prior to exactly the same procedure performed in different institutions. There are no guidelines and only scant evidence to guide practice. One can see how this inconsistency in practice has arisen. There are understandable concerns that if patients are not fasted, then their risk of complications may increase. However, these concerns are probably overstated and, indeed, it is possible that harm may be more likely to occur in fasted patients. We agree that concerns regarding a possible increased risk of pulmonary aspiration in non-fasted patients are probably unfounded. Patients who undergo primary percutaneous coronary intervention for acute ST segment elevation myocardial infarction are not fasted and there is no reported excess of peri-procedural pulmonary aspiration on the British Cardiovascular Intervention Society national registry. An open-label study by Kwon et al3 reported that no patient (fasted vs non-fasted) undergoing cerebral angiography had pulmonary aspiration. A prospective study by Agrawal et al4 demonstrated that there was no association between adverse events and not being fasted in children undergoing preprocedural sedation in emergency department. When patients are not fasted, we suspect radial access is easier and there appears to be less sedation-induced blood pressure drop. We believe that allowing patients to freely eat and drink before their scheduled procedure makes them less anxious, as described by some patients: ‘They are having a procedure, not an operation’. In centres that routinely fast their patients, delays may occur if a patient had not fasted for long enough before their scheduled procedure time or if they had inadvertently broken their fast. This may prolong inpatient stay and increase costs. We concur that more studies are required and our group is currently designing a larger, multicentre prospective study
aiming to compare the two practices (fasting vs non-fasting prior to percutaneous cardiac procedures). We suspect that our findings from that larger study will provide further evidence that preprocedural fasting is not required. Tahir Hamid,1,2 John E Macdonald,1 Kanarath P Balachandran,2 Telal Mudawi2 1
Cardiology Department, Royal Albert Edward Infirmary, Wigan, UK Royal Blackburn Hospital NHS Trust, Blackburn, UK
2
Correspondence to Dr Tahir Hamid, Cardiology Department, Royal Albert Edward Infirmary, Wigan WN1 2NN, UK; [email protected] Contributors All the coauthors have significant contribution to the work. Competing interests None. Ethics approval Local Body. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Hamid T, Macdonald JE, Balachandran K P, et al. Heart 2014;100:1988. Received 6 September 2014 Accepted 8 September 2014 Published Online First 26 September 2014
▸ http://dx.doi.org/10.1136/heartjnl-2014-305911 Heart 2014;100:1988. doi:10.1136/heartjnl-2014-306780
REFERENCES 1
2
3
4
Wijeyeratne YD, Wendler R, Spray D, et al. Pre-procedural fasting for coronary interventions: is it time to change practice? Heart 2014;100:13. Hamid T, Aleem Q, Lau Y, et al. Pre-procedural fasting for coronary interventions: is it time to change practice? Heart 2014;100:658–61. Kwon OK, Oh CW, Park H, et al. Is fasting necessary for elective cerebral angiography? AJNR Am J Neuroradiol 2011;32:908–10. Agrawal D, Manzi SF, Gupta R, et al. Pre-procedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med 2003;42:636–46.
Heart December 2014 Vol 100 No 24
Downloaded from http://heart.bmj.com/ on March 15, 2015 - Published by group.bmj.com
Re: Preprocedural fasting for coronary interventions: is it time to change practice? Tahir Hamid, John E Macdonald, Kanarath P Balachandran and Telal Mudawi Heart 2014 100: 1988 originally published online September 26, 2014
doi: 10.1136/heartjnl-2014-306780 Updated information and services can be found at: http://heart.bmj.com/content/100/24/1988
These include:
References Email alerting service
This article cites 4 articles, 3 of which you can access for free at: http://heart.bmj.com/content/100/24/1988#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
PostScript To cite Luciani GB. Heart 2014;100:1987–1988.
▸ http://dx.doi.org/10.1136/heartjnl-2014-306767 Heart 2014;100:1987–1988. doi:10.1136/heartjnl-2014-307080
REFERENCES 1
2
3
4
5
6
Luciani GB, Lucchese G, Carotti A, et al. Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry. Heart 2014;100:1954–9. Ma K, Chen Q, Li S. The role of LV in the autograft complication after ROSS operation. Heart 2014;100:1988. Hazekamp MG, Grotenhuis HB, Schoof PH, et al. Results of the Ross operation in a pediatric population. Eur J Cardiothorac Surg 2005;27: 975–9. Luciani GB, Favaro A, Casali G, et al. Ross operation in the young: a ten-year experience. Ann Thorac Surg 2005;80:2271–7. Horer J, Kasnar-Samprec J, Charitos E, et al. Patient age at the Ross operation in children influences aortic root dimensions and aortic regurgitation. World J Pediatr Congenit Heart Surg 2013;4: 245–2. Luciani GB, Lucchese G, Carotti A, et al. Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry. Heart 2014;100:1954–9.
Re: Preprocedural fasting for coronary interventions: is it time to change practice? The Authors’ reply: We read with interest the comments from Wijeyeratne et al1 regarding our paper. They commend our study2 for questioning the need for fasting prior to percutaneous cardiac procedures and highlight the lack of evidence either for or against the necessity to fast in this scenario. We agree with their comments and fully accept the limitations of our retrospectively analysed data. While we do not expect our paper to result in an immediate major practice shift in cardiology, we certainly hope that it will raise awareness of this issue.
1988
As they point out, patients might be instructed to fast, drink fluids only or not fast at all (for varying periods of time) prior to exactly the same procedure performed in different institutions. There are no guidelines and only scant evidence to guide practice. One can see how this inconsistency in practice has arisen. There are understandable concerns that if patients are not fasted, then their risk of complications may increase. However, these concerns are probably overstated and, indeed, it is possible that harm may be more likely to occur in fasted patients. We agree that concerns regarding a possible increased risk of pulmonary aspiration in non-fasted patients are probably unfounded. Patients who undergo primary percutaneous coronary intervention for acute ST segment elevation myocardial infarction are not fasted and there is no reported excess of peri-procedural pulmonary aspiration on the British Cardiovascular Intervention Society national registry. An open-label study by Kwon et al3 reported that no patient (fasted vs non-fasted) undergoing cerebral angiography had pulmonary aspiration. A prospective study by Agrawal et al4 demonstrated that there was no association between adverse events and not being fasted in children undergoing preprocedural sedation in emergency department. When patients are not fasted, we suspect radial access is easier and there appears to be less sedation-induced blood pressure drop. We believe that allowing patients to freely eat and drink before their scheduled procedure makes them less anxious, as described by some patients: ‘They are having a procedure, not an operation’. In centres that routinely fast their patients, delays may occur if a patient had not fasted for long enough before their scheduled procedure time or if they had inadvertently broken their fast. This may prolong inpatient stay and increase costs. We concur that more studies are required and our group is currently designing a larger, multicentre prospective study
aiming to compare the two practices (fasting vs non-fasting prior to percutaneous cardiac procedures). We suspect that our findings from that larger study will provide further evidence that preprocedural fasting is not required. Tahir Hamid,1,2 John E Macdonald,1 Kanarath P Balachandran,2 Telal Mudawi2 1
Cardiology Department, Royal Albert Edward Infirmary, Wigan, UK Royal Blackburn Hospital NHS Trust, Blackburn, UK
2
Correspondence to Dr Tahir Hamid, Cardiology Department, Royal Albert Edward Infirmary, Wigan WN1 2NN, UK; [email protected] Contributors All the coauthors have significant contribution to the work. Competing interests None. Ethics approval Local Body. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Hamid T, Macdonald JE, Balachandran K P, et al. Heart 2014;100:1988. Received 6 September 2014 Accepted 8 September 2014 Published Online First 26 September 2014
▸ http://dx.doi.org/10.1136/heartjnl-2014-305911 Heart 2014;100:1988. doi:10.1136/heartjnl-2014-306780
REFERENCES 1
2
3
4
Wijeyeratne YD, Wendler R, Spray D, et al. Pre-procedural fasting for coronary interventions: is it time to change practice? Heart 2014;100:13. Hamid T, Aleem Q, Lau Y, et al. Pre-procedural fasting for coronary interventions: is it time to change practice? Heart 2014;100:658–61. Kwon OK, Oh CW, Park H, et al. Is fasting necessary for elective cerebral angiography? AJNR Am J Neuroradiol 2011;32:908–10. Agrawal D, Manzi SF, Gupta R, et al. Pre-procedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med 2003;42:636–46.
Heart December 2014 Vol 100 No 24
Downloaded from http://heart.bmj.com/ on March 15, 2015 - Published by group.bmj.com
Re: Preprocedural fasting for coronary interventions: is it time to change practice? Tahir Hamid, John E Macdonald, Kanarath P Balachandran and Telal Mudawi Heart 2014 100: 1988 originally published online September 26, 2014
doi: 10.1136/heartjnl-2014-306780 Updated information and services can be found at: http://heart.bmj.com/content/100/24/1988
These include:
References Email alerting service
This article cites 4 articles, 3 of which you can access for free at: http://heart.bmj.com/content/100/24/1988#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
