Prevention of Cardiovascular Events in High Risk Patients
The following article is the result of a research study by Kuniyoshi Yagyu, M.D. and Koki Yahashi, M.D., at the Kioicho Clinic in Tokyo Japan and was presented in the 17th annual meeting of international society of hair restoration surgery in Amsterdam, Netherland.
Advance in medicine has significantly improved survival and quality of life with better midterm prognosis in patients suffering from cardiovascular or cerebrovascular diseases. Some of the patients sometimes visit our clinic for treatment of MPHL. Hair transplantation is generally considered a safe procedure, and life-threatening events during the surgery must be prevented even in high risk patients. The most serious and acute life-threatening complications in such patients will be recurrence or new onset of cardiovascular or cerebrovascular events, which need precise diagnosis and proper treatment without delay. The aim of this study is to summarize the author's experience about the management of patients in a group at high risk during hair transplantation.
Thirty-two male patients, aged 54.9±13.4 years, with diagnosed cardiovascular or cerebrovascular diseases underwent hair transplantation for these five years. They have been treated due to ischemic heart disease and angina pectoris (n=10 patients), arrhythmia including frequent premature ventricular contraction or WPW syndrome (n=8), cerebral ischemia or infarction (n=3), dissecting thoracic aortic aneurysm (n=2), and pulmonary embolism, valvular heart disease before prosthetic valve replacement, ventricular septal defect, hypertrophic cardiomyopathy, obliterative arteriosclerosis, and chronic renal failure under regular hemodialysis (each n=1). Patients included in this study were under the care of experienced cardiologists with a stable dose of drug therapy optimized for more than three months without hemodynamic and electrocardiographic complications at an outpatient clinic.
At the end of the study, all patients underwent safe and successful surgery. Monitoring of electrocardiogram, oxygen saturation (Sp02), blood pressure and heart rate were mandatory during the procedure. Prophylactic usage of nitroglycerin tape, nasal oxygen supply in necessity, and inhalation of nitroglycerin for emergency were useful. Avoidance of anxiety, distress, hypoxemia, arrhythmia, hypertension and hypotension during the procedure was important. Control of the dosage of anticoagulant and anti-platelet drugs prior to surgery was necessary. Anticipation of catastrophic situation, careful preparation for management of possible emergency situations, monitoring to detect early change of parameters, and prophylactic drugs to stabilize hemodynamic parameters were crucial.
The authors conclude that clinical hemodynamic and neurological variables can be stabilized during the procedure using careful strategies with risk stratification. Safe hair transplant surgery will be-possible in patients at high risk in relation-to cardiovascular and cerebrovascular diseases.
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