A multidisciplinary perioperative strategy for attaining "more physiologic" cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Cardiac surgery, despite advancements, remains a "non-physiologic" intervention with significant morbidity and mortality.
• Current practices in surgical technique, cardiopulmonary bypass (CPB), anesthesia, and patient care still face challenges in mitigating adverse effects.

Purpose of the Study:

• To advance patient outcomes by transitioning from "optimal perfusion" to a "more physiologic" cardiac surgery paradigm.
• To implement a multidisciplinary perioperative strategy focused on goal-directed perfusion and real-time monitoring.
• To "prevent rather than correct" malperfusion through proactive, incremental adjustments.

Main Methods:

• Continuous monitoring of key hemodynamic parameters including cardiac index, mixed venous oxygen saturation (SvO2), and regional cerebral oxygenation (rSO2).
• A stepwise intervention protocol triggered by monitoring data, involving transfusion, augmentation of cardiac output, and vasoactive/inotropic support.
• Integration of minimally invasive extracorporeal circulation (MiECC) for enhanced circulatory support and end-organ protection during CPB.

Main Results:

• The described strategy facilitates "optimal perfusion" during the perioperative period.
• Real-time adjustments based on continuous monitoring help prevent and correct malperfusion events.
• Implementation of MiECC contributes to improved circulatory dynamics and organ protection.

Conclusions:

• The adopted strategy successfully achieves the objective of a "more physiologic" cardiac surgery.
• This approach enhances perioperative perfusion, aiming to reduce the inherent risks associated with cardiac surgery.
• Continuous, goal-directed perfusion represents a significant step towards minimizing adverse outcomes in cardiac surgical patients.