Cardiac Surgery Complications
Medical Management Manual
Introduction
Open heart surgery has been in existence for
the past four to five decades. With the advance in Surgical techniques,
anesthetic improvements, and state-of-the-art post-operative suites, we
should have practically eliminated almost all postoperative complications.
Ironically, we face the same complications that we used to see twenty or
thirty years ago, though not to the same degree. We certainly have reduced
the incidence of perioperative mortality and morbidity, yet we continue to
face a long list of postoperative challenges that are listed in the table
of contents.
Majority
of the mortality and morbidity after cardiac surgery results from
complications arising from
systems other than the heart.
A small percentage of the mortality is directly related to the
cardiac complications following cardiac surgery. The sequence of events
leading up to the mortality is fairly typical. It begins with a major
insult to one particular system such as the pulmonary, neural, or
renal. Following
that the events cascade onto the other systems like a domino effect that
eventually leads to the sunset in that patient. s life. The occurrence of
such an initial insult is predictable in certain patient population even
though we can. t identify which of those patients is gong to suffer a
fatal blow from such complications. The incidence of some of these events
leading to a significant morbidity or mortality can be refused by
preventing
events
that precipitate a given complication or by early recognition treatment
that can minimize the morbidity and hopefully prevent mortality. Hence, it
is so important to have a pre operative patient profile to determine the
operative risks and also prepare the patient to reduce the morbidity and
also prevent mortality. There are certain steps to be taken during the
operative phase that also can decrease the incidence of
complications.
It is clear from the above discussion,
that there are multiple factors such as a patient profile, events
during surgery, environmental factors that can alter the course of a
patient. s recovery following cardiac
surgery.
Some complications such as a massive stroke
could rapidly deteriorate the patient. s recovery and lead to
death.Similarly, sustained hypotension can lead to multi-system failure to
a point where hope of recovery is so dismal that life supportive measures
have to be discontinued at the family. s request. Then, there are other
situations where the patient. s recovery may linger on for a few months in
the intensive care unit that can only result in a patient being
transferred into an institutional care. That is the price we have to pay
in order to help a multitude of other cardiac patients. This is also a
challenge to those of us in the medical field to constantly strive to
learn from each morbidity and mortality so that we may be able to better
to serve the next patient. Our mission here is to provide you
with all the necessary information that is recent and current in the
medical literature that provides a better understanding of the etiology,
pathophysiology of cardiac surgery complications. Then we will provide you
with a clinical diagnosis and prompt treatment plans. WE also
discuss wherever possible how you can try to minimize such complications,
reduce morbidity and improve patient. s quality of life. IT takes more
than you to achieve this. IT takes a whole village of people to accomplish
such goals in each and every one of our patients. IT takes a team
effort. The entire team effort that is directed toward one single
goal, . How to best serve our patient.. IT also needs a leader that can
inspire and instill a goal in each team member. Hopefully this book
will provide you with helpful tips on implementing such a team approach,
that can benefit your patient, your efforts, and the institution in which
you so strongly lead. Words of wisdom may sound so polite and poetic, far
from the hard labor that is demanded of you treating medical complications
in the alleys of intensive care units while you drag your feet and rub
your eyes in the wee hours of the morning. Let it be known that
complication know no time, see sweet rewards under challenging
circumstances, always proceeded by bitter time and there is no time like
now to get a better grip on your know ledge on how to manage cardiac
surgery complications. Yes indeed, your contributions are important
as the surgeon who operated on the patient, or the patient who subjected
him or herself to this greatest human experimentation in the passage of
time.
