Modifying risks to improve outcome in cardiac surgery: An anesthesiologist's perspective
Open Access
- 1 January 2017
- journal article
- review article
- Published by Medknow in Annals of Cardiac Anaesthesia
- Vol. 20 (2), 226-233
- https://doi.org/10.4103/aca.aca_20_17
Abstract
Challenging times are here for cardiac surgical and anesthesia team. The interventional cardiologist seem to have closed the flow of 'good cases' coming up for any of the surgery,; successful percutaneous interventions seem to be offering reasonable results in these patients, who therefore do not knock on the doors of the surgeons any more . It is a common experience among the cardiac anesthesiologists and surgeons that the type of the cases that come by now are high risk. That may be presence of comorbidities, ongoing medical therapies, unstable angina, uncontrolled heart failure and rhythm disturbances; and in patients with ischemic heart disease, the target coronaries are far from ideal. Several activities such as institution of preoperative supportive circulatory, ventilatory, and systemic disease control maneuvers seem to have helped improving the outcome of these 'high risk ' patients. This review attempts to look at various interventions and the resulting improvement in outcomes. Several changes have happened in the realm of cardiac surgery and several more are en route. At times, for want of evidence, maximal optimization may not take place and the patient may encounter unfavorable outcomes.. This review is an attempt to bring the focus of the members of the cardiac surgical team on the value of preoperative optimization of risks to improve the outcome. The cardiac surgical patients may broadly be divided into adults undergoing coronary artery bypass graft surgery, valve surgery and pediatric patients undergoing repair/ palliation of congenital heart ailments. Optimization of risks appear to be different in each genre of patients. This review also brings less often discussed issues such as anemia, nutritional issues and endocrine problems. The review is an attempt to data on ameliorating modifiable risk factors and altering non modifiable ones.Keywords
This publication has 50 references indexed in Scilit:
- The effect of weight loss on the outcome after coronary artery bypass grafting in obese patientsAnnals of Cardiac Anaesthesia, 2012
- Risk stratification analysis of operative mortality in isolated coronary artery bypass graft patients in Pakistan: comparison between additive and logistic EuroSCORE modelsInteractive CardioVascular and Thoracic Surgery, 2011
- Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Left Main Coronary Artery Disease (from a Two-Center Registry)The American Journal of Cardiology, 2010
- What Determines Nutritional Recovery in Malnourished Children After Correction of Congenital Heart Defects?PEDIATRICS, 2009
- Prevention of Acute Kidney Injury by Erythropoietin in Patients Undergoing Coronary Artery Bypass Grafting: A Pilot StudyAmerican Journal of Nephrology, 2009
- Patients with prior coronary artery bypass grafting have a poor outcome after myocardial infarction: an analysis of the VALsartan in acute myocardial iNfarcTion trial (VALIANT)European Heart Journal, 2009
- Acute Kidney Injury After Cardiac SurgeryCirculation, 2009
- Off-Pump Coronary Artery Bypass Surgery May Reduce the Incidence of Stroke in Patients with Significant Left Main Stem DiseaseThe Thoracic and Cardiovascular Surgeon, 2008
- Application of European system for cardiac operative risk evaluation (EuroSCORE) in coronary artery bypass surgery for TaiwaneseInteractive CardioVascular and Thoracic Surgery, 2004
- Results of coronary artery surgery in patients with poor left ventricular function (CASS).Circulation, 1983