ABSTRACT

The spectrum of cardiac surgery has changed substantially in the past decade. The complexity of cases has increased, with increases in the number of repeated procedures and the number of older and sicker patients referred for surgery. At the same time, surgical practice has changed to include minimal access approaches, off-pump cardiopulmonary bypass techniques, bypass modifications to alleviate inflammatory responses, biochemical investigations to ameliorate ischemia-reperfusion injury, and improved artificial valves (such as stentless valves). These changes have substantial implications for the long-term outcome of patients undergoing surgical interventions, and a detailed discussion of these implications is beyond the scope of this chapter. However, the prevention and treatment of acute complications remain important, particularly as the surgical population becomes older and more likely to have comorbid conditions (1). Bojar noted that after coronary bypass procedures, approximately 10% of patients will experience a complication that will require treatment, prolonged hospitalization, or both (Table 1) (1).