Preoperative evaluation
Cardiac surgery, including coronary artery bypass grafting and surgery for valvular disease, represents one of the most common classes of surgical procedures performed worldwide. Advances in the percutaneous management of coronary artery disease as well as in cardiac surgical techniques have led to improved outcomes with consequent longer life expectancy for patients.
Greater numbers of patients with depressed left ventricular function, multiple comorbidities, failed interventional procedures, and prior revascularization operations are now referred for cardiac surgery. As a result, preoperative risk assessment is even more critical to ensure the safe performance of cardiac surgical procedures and the achievement …show more content…
Attention should also be paid to the patency of the venous system in the lower extremities since extensive varicosities may necessitate the use of arm veins as conduits; if the latter are needed, then avoidance of intravenous line placement in the arm from which veins will be harvested is necessary. In the event of reoperation, noninvasive imaging of the lower extremities as well as imaging of the left internal mammary artery during cardiac catheterization may be desirable to assess patency of potential conduits.
Since neurologic status may be compromised perioperatively and/or postoperatively, carotid ultrasound should be performed on all patients, and combined endarterectomy/ CABG should be considered in those individuals with a history of prior stroke, severe bilateral stenoses, or contralateral occlusion and in patients with a history of neurologic symptoms that could represent cerebral …show more content…
Right ventricular dysfunction caused by increased pulmonary vascular resistance should be treated with inotropes that have vasodilator properties such as dobutamine (5 µg/kg/min) and milronone (5 µg/kg/min). Intravenous nitrates, prostacyclin (0.5–2.0 ng/kg/min), and nitric oxide (10–20 ppm) are also effective agents for lowering pulmonary vascular resistance with resultant improvement in right ventricular
Cardiac surgery, including coronary artery bypass grafting and surgery for valvular disease, represents one of the most common classes of surgical procedures performed worldwide. Advances in the percutaneous management of coronary artery disease as well as in cardiac surgical techniques have led to improved outcomes with consequent longer life expectancy for patients.
Greater numbers of patients with depressed left ventricular function, multiple comorbidities, failed interventional procedures, and prior revascularization operations are now referred for cardiac surgery. As a result, preoperative risk assessment is even more critical to ensure the safe performance of cardiac surgical procedures and the achievement …show more content…
Attention should also be paid to the patency of the venous system in the lower extremities since extensive varicosities may necessitate the use of arm veins as conduits; if the latter are needed, then avoidance of intravenous line placement in the arm from which veins will be harvested is necessary. In the event of reoperation, noninvasive imaging of the lower extremities as well as imaging of the left internal mammary artery during cardiac catheterization may be desirable to assess patency of potential conduits.
Since neurologic status may be compromised perioperatively and/or postoperatively, carotid ultrasound should be performed on all patients, and combined endarterectomy/ CABG should be considered in those individuals with a history of prior stroke, severe bilateral stenoses, or contralateral occlusion and in patients with a history of neurologic symptoms that could represent cerebral …show more content…
Right ventricular dysfunction caused by increased pulmonary vascular resistance should be treated with inotropes that have vasodilator properties such as dobutamine (5 µg/kg/min) and milronone (5 µg/kg/min). Intravenous nitrates, prostacyclin (0.5–2.0 ng/kg/min), and nitric oxide (10–20 ppm) are also effective agents for lowering pulmonary vascular resistance with resultant improvement in right ventricular