New paradigms in cardiovascular medicine: emerging technologies and practices: perioperative genomics.
Considerable progress has been made in understanding the pathophysiology of perioperative stress responses and their impact on the cardiovascular system; however, researchers are just beginning to unravel genetic and molecular determinants that predispose to increased risk for postoperative cardiovascular adverse events. A new field, coined perioperative genomics, aims to apply functional genomic approaches to uncover the biological reasons why similar patients can have dramatically different clinical outcomes after surgery. For the perioperative physician, such findings may soon translate into prospective risk assessment incorporating genomic profiling of markers important in inflammatory, thrombotic, vascular, and neurologic responses to perioperative stress, with implications ranging from individualized additional pre-operative testing and physiological optimization, to perioperative decision-making, choice of monitoring strategies, and critical care resource utilization. We review current knowledge regarding genomic technologies in perioperative cardiovascular disease characterization and outcome prediction, as well as discuss future trends/challenges for translating integrated "omic" information into daily clinical management of the surgical patient.
Podgoreanu
Mihai V
MV
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. mihai.podgoreanu@duke.edu
Schwinn
Debra A
DA
D000818:Animals; D001057:Apolipoproteins E / Q000235:genetics; D001281:Atrial Fibrillation / Q000235:genetics; D001777:Blood Coagulation / Q000235:genetics; D002315:Cardiopulmonary Bypass; D002318:Cardiovascular Diseases / Q000235:genetics*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000235:genetics; D020869:Gene Expression Profiling; D020022:Genetic Predisposition to Disease; D023281:Genomics; D006084:Graft Rejection / Q000235:genetics; D006488:Hemostasis, Surgical; D006801:Humans; D007249:Inflammation / Q000235:genetics; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology / Q000235:genetics; D020411:Oligonucleotide Array Sequence Analysis; D019990:Perioperative Care; D010597:Pharmacogenetics; D011110:Polymorphism, Genetic; D011183:Postoperative Complications / Q000503:physiopathology; D018570:Risk Assessment; D020257:Ventricular Remodeling
D001057:Apolipoproteins E