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Modifying risks to improve outcome in cardiac surgery: An anesthesiologist's perspective
1Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India.
Insights
Cardiac surgery patients are increasingly high-risk. Preoperative optimization of modifiable risk factors is crucial for improving outcomes in complex cardiac surgical cases.
Area of Science:
- Cardiology
- Anesthesiology
- Cardiac Surgery
Background:
- Interventional cardiology advances reduce 'good' surgical cases.
- Cardiac surgical teams now manage high-risk patients with comorbidities and complex conditions.
- Traditional surgical case mix has shifted towards sicker patients.
Purpose of the Study:
- To review interventions for improving outcomes in high-risk cardiac surgical patients.
- To emphasize the importance of preoperative risk optimization in cardiac surgery.
- To explore risk optimization strategies across different patient groups (adults, pediatrics) and conditions.
Main Methods:
- Literature review of preoperative interventions and outcomes in cardiac surgery.
- Analysis of strategies for optimizing risk factors in adults (CABG, valve surgery) and pediatric patients.
- Discussion of less-discussed issues like anemia, nutrition, and endocrine problems.
Main Results:
- Preoperative optimization of circulatory, ventilatory, and systemic disease control improves outcomes.
- Risk optimization strategies vary for different cardiac surgical patient genres.
- Addressing modifiable risk factors like anemia and nutritional status is key.
Conclusions:
- Preoperative optimization is vital for improving outcomes in high-risk cardiac surgery.
- Tailored risk management is necessary for diverse patient populations.
- Further research and evidence are needed to maximize patient outcomes.
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.