Management strategies for high-risk cardiac surgery: improving outcomes in patients with heart failure.
BACKGROUND
Surgical heart failure management is the fastest growing aspect of cardio-vascular surgery. Advances in cardiac surgical techniques have changed the number and types of operations permitted physicians and thus broadened the complexity of patients recommended for operation.


METHODS
Surgeons, anesthesiologists and cardiologists face hemodynamic and patho-physiological challenges that can be optimally overcome only by modifying treatment strategies. Because many treatment standards are still evolving in this rapidly advancing field, a team of cardiovascular surgeons and anesthesiologists convened to share clinical experience and impressions and discuss practical issues related to high-risk patients undergoing heart surgery.


RESULTS
Heart failure pathophysiology, surgical heart failure management, including mitral reconstruction and left ventricular remodeling, cardiopulmonary bypass weaning, inotropic support, transesophageal echocardiography and acute cardiovascular collapse after cardiac surgery are discussed.


CONCLUSIONS
This article is intended to guide clinicians to improve patient care and outcomes in this special population by providing specific guidance on the appropriate use of inotropic and mechanical support in patients undergoing high-risk procedures using innovative techniques.
Bolling
S F
SF
University of Michigan, Ann Arbor, USA.
Dickstein
M L
ML
Levy
J H
JH
McCarthy
P M
PM
Oz
M C
MC
Savage
R M
RM
D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome