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Postoperative complications Bleeding Significant bleeding occurs in approximately 2–3% of patients. Rarely , acute cardiac tamponade or profound hypotension may occur in the early postoperative period and requires emergency resternotomy . Arrhythmias The most c...

Postoperative management Antibiotic prophylaxis Currently the National Institute for Health and Care Excellence recommends that prophylactic antibiotics are not required for patients with prosthetic valves undergoing dental procedures. Other leading European b...

Postoperative recovery The majority of patients are extubated a few hours postoper atively and remain in the ICU for 24 hours. In some centres, ‘fast tracking’ appropriate patients allows earlier transfer to a recovery area or high-dependency unit. Discharge ...

Preparation for surgery Clinical assessment Before CABG, the severity and stability of the patient’s IHD, the presence of significant valvular disease and the status of left ventricular function should be properly evaluated. Any comorbid risk factors for IHD ...

Primary malignant cardiac tumours These are extremely rare and less common than secondary malignancies. They include angiosarcoma, rhabdomyosar - - coma and leiomyosarcoma. Patients usually have advanced - disease when they are discovered, and they are associa...

Prosthetic valve dysfunction and complications Structural valve failure Structural failure rates for the currently used bioprosthetic valves, although rare in those over 70 years of age, can reach 60% after 15 years. Structural failure of a mechanical - valv...

Rhabdomyoma Cardiac tumours in children are incredibly rare (<0.2% of the population), although this is the most common benign cardiac tumour. It usually presents with symptoms related to valve dysfunction or arrhythmias. There are usually multicentric peduncu...

Selection of conduit Venous grafts The long saphenous vein is the most commonly used venous conduit as it is straightforward to harvest, provides good length and is easy to handle. Historical studies showed a limited long - term patency rate for long saphenou...

Surgical anatomy Heart valves serve to maintain pressure gradients between cardiac chambers, thus ensuring a unidirectional flow of blood through the heart. The aortic valve is tricuspid, with semilunar leaflets attached to the aortic wall at the annulus, the ao...

Surgical approach to the heart Median sternotomy is the main approach during cardiac surgery . An incision is made from the suprasternal notch to the xiphisternum. The sternum is divided in the midline and retracted, exposing the thymus superiorly and pericard...

Surgical options Type A (or type I and II) dissections Those involving the ascending aorta usually require surgical intervention. The chest is opened through a median sternot omy and CPB is commenced, often with core cooling down to 18°C based on the technique...

Surgical outcome Relief of symptoms If revascularisation is complete, CABG alleviates or improves anginal symptoms in more than 90% of patients at 1 year; this falls to 80% at 5 years and 60% at 10 years. This symptomatic deterioration usually reflects progres...

THE THORACIC AORTA The most common pathologies a ff ecting the thoracic aorta are aneurysm formation and aortic dissection.

The operation Intraoperative monitoring includes continuous central venous pressure and blood pressure recording (via a central line in the internal jugular or subclavian vein and radial artery line, respectively), urine output via a urinary catheter, temperat...

Thoracic aortic aneurysms A true aneurysm is a localised dilatation of a blood vessel involving all three layers of the vessel wall, whereas a false aneurysm has compressed supporting tissue as its wall and is usually the result of a defect in the vessel in...

Types of prosthetic valves Mechanical valves Mechanical valves can be used in any age group to replace any valve ( Figure 59.10 ). They are extremely durable but thrombogenic and patients require systemic anticoagulation, usually with warfarin. The patient sho...

VALVULAR HEART DISEASE Introduction Early surgical management of valvular heart disease concen - trated on valve repair. The heroic early procedures for valve stenosis were closed and therefore ‘blind’ commissurotomies ® Figure 59.8 Off-pump coronary artery b...

Venous cannulation A single purse-string suture is placed around the right atrial appendage and a single ‘two-stage’ venous cannula is placed to establish venous drainage. The venous pipe has end holes that sit in the inferior vena cava and side holes that sit...