When I do a pre-operative evaluation for a cardiac patient, I naturally focus on the heart. What is the pathology? The EKG results? The echocardiogram? The cardiac cath? This helps guide my anesthetic induction, parameters for blood pressure, choice of monitors, and vasoactive drips. However, everything else matters too. In the last month, I've seen the gamut of outcomes from cardiac surgery. I did a 3 vessel coronary artery bypass graft the other day and an aortic valve replacement today in relatively healthy patients with no surgical complications or delay. The bypass time was minimal, and the patients did spectacularly. This is the way surgery should be; the patients are extubated quickly, transferred out of the ICU, and return home in a matter of days.
On the other hand, I had a case with a patient on dialysis, a long standing smoking history, and a bypass time of 8 hours, and that did not go smoothly. The patient received a lot of blood products and needed to be dialyzed. He continued to bleed and had to go back to the operating room to get better surgical hemostasis. He had a prolonged time on the ventilator and a long ICU course. Despite doing everything the best we could, we struggled to get him through the surgery.
I write about this only because it fascinates me that the heart is the most central organ to the body and we focus so much on it, but everything else plays such an important role in how well patients do after heart surgery.
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