Cardiovascular failure and pharmacologic support after cardiac surgery

Improved techniques for intraoperative myocardial preservation have permitt ed application of cardiac surgery to younger and smaller children with cong enital heart disease and to older and sicker adults with coronary and valvu lar heart disease. Many of these patients experience myocardial failure pos toperatively, and require variable periods of positive inotropic drug suppo rt. A variety of positive inotropic drugs have shown efficacy in these circ umstances, in some cases when administered alone, and in others when admini stered with other positive inotropes and other vasoactive agents. Conversel y, some drugs and drug combinations have proven inferior to others. Careful titration of the appropriate agent, with a full understanding of its poten tial for adverse side effects and with frequent assessment of the adequacy of drug response, should provide the greatest likelihood of therapeutic suc cess and accelerated recovery.