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New Paradigms in Cardiovascular Medicine

Emerging Technologies and Practices: Perioperative Genomics

Mihai V. Podgoreanu, MD^_*,_* and Debra A. Schwinn, MD^_*,,,

^_* Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
Department of Pharmacology/Cancer Biology, Duke University Medical Center, Durham, North Carolina
Department of Surgery, Duke University Medical Center, Durham, North Carolina
Center for Genomic Medicine, Duke Institute for Genome Science and Policy, Durham, North Carolina.

View larger version (28K): [in a new window]   Figure 1 Perioperative outcomes are complex traits, characteristically involving multiple gene-gene interactions and gene-environment interactions to produce a final clinical phenotype (presence/absence and severity of an adverse event). CPB = cardiopulmonary bypass; OR = operating room.

View larger version (23K): [in a new window]   Figure 2 Biological systems and mechanistic pathways genetically associated with perioperative adverse events.

View larger version (50K): [in a new window]   Figure 3 The degree of perioperative myocardial injury is a result of the balance between injurious and cardioprotective (endogenous and exogenous) biological mechanisms, mediated via a wide array of biochemical pathways with extensive genetic variability. AR = adrenergic receptor; CPB = cardiopulmonary bypass; EC = endothelial cells; PMN = polymorphonuclear neutrophils; RNS = reactive nitrogen species; ROS = reactive oxygen species.