ABSTRACT
Introduction Extubation in the operating room or soon thereafter is now well-established after cardiac surgery, and in many patients, routine admission to the intensive therapy unit (ITU) may be avoided.1,2 Because of these and other developments in perioperative care, coupled with the use of lessinvasive surgical techniques, many cardiac surgical patients may now have a routine postoperative care. However, with medical therapy and the increasing use of percutaneous approaches to coronary artery disease, as well as increasing longevity of the population, many patients who now present for cardiac surgery are extremely high risk, and therefore may have a complex perioperative course. Perioperative mortality remains significant in these patients, especially those patients having complex valve procedures, double valve replacements, combined valve and coronary artery surgery and thoracoabdominal aortic surgery. The development of postoperative complications such as prolonged mechanical ventilation, renal failure, stroke and reoperation for bleeding, significantly increase mortality.3
