Cardiovascular Complications and Management After Cardiac Surgery

Abstract

The essential principle in post-cardiac surgical care is ensuring optimal hemodynamic preservation and tissue perfusion through the utilization of continuous hemodynamic monitoring, adequate volume repletion, and, if necessary, use of inotropic agents and/or pressors. Cardiopulmonary resuscitation (CPR) for cardiac arrest after cardiac surgery is different from cardiac arrest in other settings as its causes are usually reversible with associated improved outcomes.

Due to aging of the cardiac surgical population and broader application of interventional cardiologic interventions before admission for cardiac surgery, the profile of patients has changed. Cardiac surgical patients in the twenty-first century are older and sicker, possess diminished physiologic reserve, manifest decreased ventricular function, are referred for more complex procedures, and are at high risk for postoperative major cardiac complications in comparison with other patient populations. The main insult sustained by the patient is related to inadequate myocardial contraction that results in a low cardiac output syndrome. Inability to wean from cardiopulmonary bypass created more emphasis in evaluating means of more prolonged supportive measures. Innovative techniques for circulatory support devices have developed, and different types are now available. Initially intra-aortic balloon pumps (IABP) and centrifugal pumps were developed, whereas now rapidly evolving technical changes have led to new and improved pneumatic and electrically driven internal assist devices. These devices are being increasingly inserted in an effort to provide supportive assistance to one or both ventricles with increased safety and durability.