Management Strategies for High-Risk Cardiac Surgery: Improving Outcomes in Patients with Heart Failure

(#2000-0734 ... September 11, 2000)

Steven F. Bolling, MD,¹ Marc L. Dickstein, MD,² Jerrold H. Levy, MD,³ Patrick M. McCarthy, MD,⁴ Mehmet C. Oz, MD,² Robert M. Savage, MD, FACC⁴

¹University of Michigan, Ann Arbor, Michigan
²Columbia Presbyterian Medical Center, New York, New York
³Emory University Hospital, Atlanta, Georgia
⁴The Cleveland Clinic Foundation, Cleveland, Ohio

The Heart Surgery Forum #2000-0734 3(4):337-349, 2000

ABSTRACT

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 impres-sions 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.

Conclusion: 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.

AUTHOR/ARTICLE INFORMATION

Submitted August 29, 2000; accepted September 11, 2000.

Address correspondence and reprint requests to: Mehmet C. Oz, MD, Irving Assistant Professor of Surgery, Division of Cardiothoracic Surgery, College of Physicians & Surgeons, Columbia University, Milstein 7-435, 177 Ft. Washington Ave., New York, NY 10032, Phone: 212-305-4434, Fax: 212-305-2439, Email: mco2@columbia.edu

Key words: Cardiomyopathy, cardiopulmonary bypass, heart failure, infarct exclusion, inotropic support, mitral valve, transesophageal echocardiography, ventricular assist device