RT Book, Section
A1 Ruff, Christian T.
A1 O’Gara, Patrick T.
A2 Cohn, Lawrence H.
A2 Adams, David H.
SR Print(0)
ID 1144150143
T1 Preoperative Evaluation for Cardiac Surgery
T2 Cardiac Surgery in the Adult, 5e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071844871
LK accesscardiology.mhmedical.com/content.aspx?aid=1144150143
RD 2024/04/19
AB Advances  in  surgical  techniques  and  improved  patient  outcomes  have  enabled  the  application  of  cardiac  surgery  in  patient  populations  previously  considered  ineligible  for  an  intervention  of  this  magnitude.  The  decision  to  intervene  surgically,  as  well  as  the  type  of  intervention  best  suited  to  the  patient,  should  be  based  on  an  individual  risk-benefit  analysis.  The  risks  of  the  procedure,  including  major  morbidities  and  short-  and  intermediate-term  mortality,  must  be  weighed  against  the  expected  benefits  with  respect  to  longevity,  symptom  relief,  and  improved  functional  capacity.  This  chapter  reviews  the  essential  information  that  the  cardiologist  and  surgeon  must  collect  and  review  to  evaluate  a  patient  for  cardiac  surgery  (Table  10-1).  This  information  includes  patient  and  disease  characteristics  as  well  as  surgical  considerations  that  can  be  integrated  into  scoring  systems  that  provide  a  semi-quantitative  risk  assessment.  With  the  ever-evolving  complexity  of  patients  requiring  specialized  cardiovascular  care,  the  refinement  of  surgical  techniques,  and  the  emergence  of  less  invasive  alternatives  for  high-risk  patients,  it  has  become  apparent  that  there  are  important  limitations  to  these  scores  in  that  they  do  not  adequately  account  for  procedure-specific  impediments,  major  organ  system  compromise,  and  patient  frailty.  In  addition,  there  has  been  recognition  that  risk  assessment  must  occur  in  a  framework  of  shared  decision  making  that  ensures  that  patients  and  their  families  have  a  thorough  understanding  of  the  relative  risks  and  benefits  of  the  various  treatment  options  and,  most  importantly,  that  their  wishes  and  preferences  are  respected  in  the  therapeutic  plan.  There  has  been  increasing  recognition  that  a  Heart  Team  approach  that  draws  on  the  strength  of  multidisciplinary  participation  in  decision  making  may  be  ideally  suited  to  meet  this  challenge.