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Improving Outcomes in Cardiac Surgery: Recognizing Complications and Enhancing Care

Discover how morbidity and mortality rates in cardiac surgery have decreased with better techniques, infection prevention, and knowledge of complications across three time periods: immediate post-op, short-term post-op, and long-term post-op.

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Improving Outcomes in Cardiac Surgery: Recognizing Complications and Enhancing Care

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  1. Morning Report October 7, 2010

  2. Complications of Cardiac Surgery • Morbidity and Mortality rates have decreased • Better techniques • Prevention of infections • Better knowledge of complications • Three time periods • Immediate post-op • Short-term post-op • Long-term post-op

  3. Cardiac Surgery • Immediate post-op • Intubation • Anesthetic agents • Blood loss • Fluid management • Length of time on bypass

  4. Cardiac Surgery • Immediate post-op • Respiratory • Intubation • Vocal cord damage • Secretions • Low cardiac output • Tachycardia, decreased UOP, decreased BP • Fluid vs pump failure • Arrhythmias • Any surgery near the atria • Tachycardia • Bradycardia

  5. Cardiac Surgery • Immediate post-op • HTN • Coarctation or PDA • Managed medically but usually short lived • Coarctation • Postcoarctation syndrome • Abd pain, infarction of bowel • Chylothorax • Creamy fluid in chest tubes, high fat content, negative culture • Damage to thoracic duct • Modify diet – low fat • Portagen for babies • May reside on own or require chest tubes or surgery

  6. Cardiac Surgery • Short-term post-op • Postpericardiotomy Syndrome • Febrile illness • 7-10 post op day • Pericardial and/or pleural reaction • Children>Infants • Extensive procedures • Most cases are mild • May only be found on post op echo as an effusion

  7. Cardiac Surgery • Short-term post-op • Postpericardiotomy Syndrome • Symptoms • Fever into second post-op week • Or may return in 2nd or 3rd week • Anterior precordial chest pain • Increases on deep inspiration • Increases when supine • Intermittent friction rub

  8. Cardiac Surgery • Short-term post-op • Postpericardiotomy Syndrome • Lab findings • Increased WBC • Left shift • Increased ESR • ECG • Flattened or inverted T waves • Echo • Pericardial effustion

  9. Cardiac Surgery • Short-term post-op • Postpericardiotomy Syndrome • Usually self limited • Persistence of effusion is concerning • Tamponade • Muffled heart sounds, pulsusparadoxus, JVD • Antiinflammatory agents • ASA or steroids

  10. Cardiac Surgery • Long-term post-op • Infective Endocardits

  11. Cardiac Surgery • Long-term post-op • Infective Endocardits

  12. Cardiac Surgery • Long-term post-op • Arrhythmia • Sick sinus syndrome • Syncope • PVCs • Need further monitoring • CHF • Condition not relieved • Injury to a critical area • High cardiac burden before surgery

  13. Cardiac Surgery • Long-term post-op • Valvular regurgitation • Even with good initial results • May need second surgery • Aortopathy • Progressive dilation of ascending aorta • Coarctations • Close follow up

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