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cardiac surgery (heart surgery)

Indications: - heart disease, including valvular heart disease not amenable to medical treatment Adverse effects: - risk of cognitive impairment after CABG, PCI or cardiac valve replacement is uncertain [3] Complications: - acute renal failure - chronic renal failure is strongest nonmodificable risk factor [4] - low cardiac output syndrome [6] - postoperative cardiac arrhythmias after cardiac surgery [7] - supraventricular arrhythmias & ventricular arrhythmias Management: - perioperative colchicine [1] - reduces postpericardiotomy syndrome - does not reduce postoperative atrial fibrillation - does not reduce pericardial effusions - does not reduce pleural effusions - increases gastrointestinal adverse events - postoperative potassium in the absence of hypokalemia does not reduce risk of postoperative atrial fibrillation [12] - perioperative rosuvastatin (20 mg/day) begun 8 days priorto surgery & continued for 5 days after surgery does not reduce postoperative complications in patients undergoing elective cardiac surgery [5] - preoperative chlorhexidine mouthwash reduces risk of postoperative pneumonia in patients undergoing cardiac surgery [11] - effect in other surgery unknown - blood transfusion threshold: hemoglobin < 9 g/dL [2] - lower 3-month mortality than hemoglobin < 7 g/dL - levosimendan of no benefit in preventing low cardiac output after cardiac bypass surgery in the elderly [6] - perioperative beta-blockade of benefit in reducing incidence of cardiac arrhythmias [7] - left atrial appendage occlusion during cardiac surgery to prevent stroke [10] - cardiac rehabilitation beneficial after cardiac valve surgery [9] Notes: - see surgery

Specific

aortic valve surgery arterial switch operation Blalock-Taussig procedure; Blalock-Thomas-Taussig shunt cardiac massage cardiac valve repair cardiac valve replacement cardiac valvuloplasty cardiectomy cardiomyoplasty cardiomyotomy (Heller's cardiomyotomy) cardiotomy coronary artery bypass grafting (CABG) coronary stent/coronary stenting left atrial appendage closure (Watchman device, Lariat device) left ventricular reduction surgery (Batista procedure) maze procedure mitral valve surgery myocardial resection Norwood procedure open heart surgery pericardial window pericardiectomy pericardiocentesis pericardiotomy repair of cardiac septal defect repair of cardiac wound repair of congenital heart disease repair of patent ductus arteriosus Ross procedure septal reduction therapy valvotomy

General

cardiothoracic surgery cardiovascular surgery

References

  1. Imazio M et al Colchicine for Prevention of Postpericardiotomy Syndrome and Postoperative Atrial FibrillationThe COPPS-2 Randomized Clinical Trial. JAMA. Published online August 30, 2014 PMID: 25172965 http://jama.jamanetwork.com/article.aspx?articleid=1900482
  2. Murphy GJ et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med 2015 Mar 12; 372:997. PMID: 25760354 http://www.nejm.org/doi/full/10.1056/NEJMoa1403612 - Spertus J. "TITRe"ing the approach to transfusions after cardiac surgery. N Engl J Med 2015 Mar 12; 372:1069. PMID: 25760360 http://www.nejm.org/doi/full/10.1056/NEJMe1415394
  3. Fink HA, Hemmy LS, MacDonald R et al Intermediate- and Long-Term Cognitive Outcomes After Cardiovascular Procedures in Older Adults: A Systematic Review. Ann Intern Med. 2015;163(2):107-117 PMID: 26192563 http://annals.org/article.aspx?articleid=2397694
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  5. Zheng Z, Jayaram R, Jiang J et al Perioperative Rosuvastatin in Cardiac Surgery. N Engl J Med 2016; 374:1744-1753. May 5, 2016 PMID: 27144849
  6. Mehta RH, Leimberger JD, van Diepen S et al. Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery. N Engl J Med 2017 Mar 19 PMID: 28316276 Free Article http://www.nejm.org/doi/10.1056/NEJMoa1616218
  7. Blessberger H, Kammler J, Domanovits H et al. Perioperative beta-blockers for preventing surgery-related mortality and morbidity. Cochrane Database Syst Rev. 2014;(9):CD004476 PMID: 25233038
  8. Boer C, Meesters MI, Milojevic M, et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):88-120. PMID: 29029990 Free Article http://www.jcvaonline.com/article/S1053-0770(17)30552-9/fulltext
  9. Patel DK, Duncan MS, Shah AS et al Association of Cardiac Rehabilitation With Decreased Hospitalization and Mortality Risk After Cardiac Valve Surgery. JAMA Cardiol. Published online October 23, 2019. PMID: 31642866 https://jamanetwork.com/journals/jamacardiology/article-abstract/2753611
  10. Whitlock RP, Belley-Cote EP, Paparella D et al Left atrial appendage occlusion during cardiac surgery to prevent stroke. N Engl J Med 2021 May 15; [e-pub] PMID: 33999547 https://www.nejm.org/doi/10.1056/NEJMoa2101897
  11. Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Moonesinghe SR. Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ. 2020 Mar 11;368:m540 PMID: 32161042 PMCID: PMC7190038 Free PMC article
  12. Bosworth T Skip Potassium After Cardiac Surgery Medscape. September 03, 2024 https://www.medscape.com/viewarticle/skip-potassium-after-cardiac-surgery-2024a1000fxa