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Minerva Anestesiologica 2008 December;74(12):715-25


language: English

Tricks and pitfalls regarding the hemodynamics of patients undergoing non-transplantation surgery for heart failure

Crescenzi G. 1, 2, Pappalardo F. 1, 2, Rosica C. 1, 2, Gonfalini M. 1, 2, Landoni G. 1, 2, Zangrillo A. 1, 2

1 Department of Cardiothoracic Anesthesia and Intensive Care, Vita-Salute University, San Raffaele Hospital, Milan, Italy; 2 San Raffaele Scientific Institute, Milan, Italy


This paper aims to address the mechanisms responsible for poor perioperative cardiac performance, analyzing the pathophysiology of heart failure and the main hemodynamic parameters (contractility, preload, afterload, systemic vascular resistance, and pulmonary artery pressure) used in diagnosing patients and assessing their response to therapy. It will also discuss potential therapeutic approaches to cardiac surgery patients. With advances in monitoring and life support, our critically ill patients often become trapped in a sheer, impenetrable net of wires and tubes. Unfortunately, technology can seriously compromise patient safety if the data obtained is misinterpreted. While advanced technology has become a part of daily life in the Intensive Care Unit (ICU), there remains a crucial step that cannot be performed by computers: the link from sensors to patient status. We should always remember to look past the cables and monitors and to look at the patient. This would not only reduce the number of ever-present wires, but would also help improve patient outcome. The field of non-transplant cardiac surgery for heart failure is extremely challenging for the cardiac anesthesiologist. The high incidence of postoperative low cardiac output syndrome should mandate aggressive monitoring and therapy. Nevertheless, a comprehensive understanding of the pathophysiology of heart failure and the hemodynamic implications of surgical therapies is mandatory for optimal patient management. In particular, the presence of systolic dysfunction should not automatically rule out other potential causes of poor global cardiac performance.

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