Cardiac surgery

Approximately 646,000 open heart procedures performed annually in the U.S.

Approximately 1-1.25 million patients worldwide undergo such procedures.

60 day mortality twice as high in patients transfused with unmodified RBC’s versus leukocyte depleted RBC’s (7.9% v.3.6%).

Perioperative myocardial infarction is an important complication after cardiac surgery that leads to excessive perioperative mortality, and may be caused by inadequately treated preoperative ischemia, insufficient interoperative myocardial protection, or untoward surgical events such as incomplete revascularization, graft failure, or embolization.

Readmission to hospital after cardiac surgery is common, occurring in 8-24% of discharged patients within 30 days of discharge.

Unplanned readmission within 30 days associated with diabetes, female sex, chronic lung problems, preoperative atrial fibrillation and preoperative chronic renal insufficiency.

High risk procedures such as repeat coronary artery bypass, valve replacements and combined procedures associated with increased risk of death, bleeding, renal failure, and thrombotic complications, compared to first time CABG procedures.

With coronary artery bypass grafting and valvular surgery have a perioperative myocardial infarction rate of 7-15%.

Postoperative atrial fibrillation ranges between 27-40% of cases.

Intravenous hydrocortisone reduces the relative risk of postoperative AF by 37% compared with placebo in patients undergoing CABG surgery, aortic valve replacement or combined CABG and aortic valve replacement.

Intraoperative hyperglycemia is an independent risk factor for complications, including death and improved glucose control should be attempted to reduce risks in diabetic patients.

Associated with a high rate of the blood transfusions, ranging from 40-90%.

Acute kidney injury complicates cardiac surgery in up to 30% of patients.

AKI that requires kidney replacement therapy after cardiac surgery is associated with an increased 28 day mortality ranging from 15 to 85%, depending on acute and chronic comorabilities.

AKI complicates recovery from cardiac surgery in up to 40% of patients impairing heart, lungs, brain, and gut functions and is associated with increased risk of death during hospitalization.

Even mild postoperative acute kidney injury associated with a 5-fold increase in death while in the hospital.

Acute kidney injury following cardiac surgery associated with higher rates of postoperative arrhythmias, respiratory failure, systemic infection, and myocardial infarction.

Cardiac impairment leads to kidney diseases, and kidney impairment leads to cardiac diseases.

AKI that requires kidney replacement therapy after cardiac surgery is associated with an increased 28 day mortality ranging from 15 to 85%, depending on acute and chronic comorbidities.

Patients with the serum creatinine after cardiac surgery that increased greater than 0.5 mg/dL have a 30 day mortality of 32.5%.

In a comparative trial of 428 patients undergoing CABG, reducing the hemoglobin trigger for blood transfusions to 8 g/dL does not adversely affect patient outcomes (Bracey AW et al).

Excessive bleeding requiring blood component transfusion is common after cardiac surgery and is associated with increased morbidity and mortality.

Cardiac surgery related bleeding is often multi factorial and includes acquired hypofibrinogenemia, which is treated with either cryoprecipitate or fibrinogen concentrate.

In patients undergoing cardiac fever surgery who developed clinically significant bleeding with hypo fibrinogenemia after cardiac pulmonary bypass, fibrinogen concentrate is non-inferior to cryoprecipitate with regard to the number of blood components transfused in a 24 hours post bypass.

The levels of high sensitivity troponin I after cardiac surgery are associated with increased risk of death within 30 days and are substantially higher than levels currently recommended to define clinically important peri2procedural myocardial injury (VISION cardiac surgery investigators).

Optimal fluid therapy in cardiac surgery remains controversial.

Colloids may maintain hemodynamics better than crystalloids and maybe more suitable for restricted fluid therapy.

Among patients undergoing cardiac surgery with cardiopulmonary bypass, treatment with 4% albumin solution for priming and perioperative intravenous Von your placement solution compared with Rinkers acetate did not significantly reduce the risk of major adverse events over the following 90 days: these findings cannot support the use of 4% albumin solution in this setting ( Pesonen, E).

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