Management strategies for high-risk cardiac surgery: Improving outcomes inpatients with heart failure

BACKGROUND: Surgical heart failure management is the fastest growing aspect of cardio-vascular surgery. Advances in cardiac surgical techniques have c hanged the number and types of operations permitted physicians and thus bro adened the complexity of patients recommended for operation. METHODS: Surgeons, anesthesiologists and cardiologists face hemodynamic and patho-physiological challenges that can be optimally overcome only by modi fying treatment strategies. Because many treatment standards are still evol ving in this rapidly advancing field, a team of cardiovascular surgeons and anesthesiologists convened to share clinical experience and impres-sions a nd discuss practical issues related to high-risk patients undergoing heart surgery. RESULTS: Heart failure pathophysiology, surgical heart failure management, including mitral reconstruction and left ventricular remodeling, cardiopulm onary bypass weaning, inotropic support, transesophageal echocardiography a nd acute cardiovascular collapse after cardiac surgery are discussed. CONCLUSION: This article is intended to guide clinicians to improve patient care and outcomes in this special population by providing specific guidanc e on the appropriate use of inotropic and mechanical support in patients un dergoing high-risk procedures using innovative techniques.