Indications for Adult Cardiac Surgery
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OVERVIEW
Common disorders requiring cardiac surgery:
- coronary artery disease
- aortic valve disease
- mitral valve disease
CORONARY ARTERY DISEASE
General – based on:
- symptoms
- left ventricular function (improves post surgery if reduced)
- area of ischaemia
- anatomic localisation of coronary artery stenosis
Specific Lesions
- left main stem > 50% stenosis
- proximal LAD or proximal LCx > 70%
- triple vessel disease with >70% stenosis in all 3 coronary territories
- significant proximal LAD stenosis with 2 vessel disease
Trials
- early 1990’s
- three large MRCT comparing CABG vs medical treatment -> all showed benefit
- important differences in current practice: patients < 65 years, no arterial grafts, newer medical therapies (statins) not available which have been shown to prolong life after CABG.
Risk Predictors (can use Euroscore)
- age
- DM
- COPD
- renal failure
- previous surgery
- left ventricular dysfunction
- pulmonary hypertension
- emergency operation
AORTIC VALVE
Aortic stenosis
- symptomatic
- valve area (severe < 1cm2)
Aortic regurgitation
- NYHA class III or IV symptoms due to AR
- LVEF <25% or end systolic dimension >60mm or both
- LVEF 25-50% (controversial)
- AR with root dilatation
MITRAL VALVE
Mitral stenosis
- valve area (severe < 1.5cm2) and symptomatic (NYHA III or IV)
Mitral regurgitation
- symptomatic
- asymptomatic patients with LV dysfunction
- acute AF due to MR
References and Links
- Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clinic proceedings. 85(5):483-500. 2010. [pubmed]
- Nishimura RA, Otto CM, Bonow RO. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 63(22):e57-185. 2014. [pubmed]
- Vahanian A, Alfieri O, Andreotti F. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 42(4):S1-44. 2012. [pubmed]
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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