New Paradigms in Cardiovascular Medicine
Emerging Technologies and Practices: Perioperative Genomics
Mihai V. Podgoreanu, MD**,* and
Debra A. Schwinn, MD*, , ,
* Anesthesiology
Pharmacology/Cancer Biology
Surgery, Duke University Medical Center, Durham, North Carolina
Center for Genomic Medicine, Duke Institute for Genome Science and Policy, Durham, North Carolina. Supported in part by grants AG17556 and HL075273 (to Dr. Schwinn) from the National Institutes of Health and grant 0120492U (to Dr. Podgoreanu) from the American Heart Association.
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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.
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Figure 2 Biological systems and mechanistic pathways genetically associated with perioperative adverse events.
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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.
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