Clinical review: practical recommendations on the management of perioperative heart failure in cardiac surgery.

Détails

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Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_0C2A8440A75E
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
Clinical review: practical recommendations on the management of perioperative heart failure in cardiac surgery.
Périodique
Critical Care
Auteur(s)
Mebazaa Alexandre, Pitsis Antonis A., Rudiger Alain, Toller Wolfgang, Longrois Dan, Ricksten Sven-Erik, Bobek Ilona, De Hert Stefan, Wieselthaler Georg, Schirmer Uwe, von Segesser Ludwig K., Sander Michael, Poldermans Don, Ranucci Marco, Karpati Peter C. J., Wouters Patrick, Seeberger Manfred, Schmid Edith R., Weder Walter, Follath Ferenc
ISSN
1466-609X
ISSN-L
1364-8535
Statut éditorial
Publié
Date de publication
2010
Peer-reviewed
Oui
Volume
14
Numéro
2
Pages
201
Langue
anglais
Résumé
Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery. EuroSCORE reliably predicts perioperative cardiovascular alteration in patients aged less than 80 years. Preoperative B-type natriuretic peptide level is an additional risk stratification factor. Aggressively preserving heart function during cardiosurgery is a major goal. Volatile anaesthetics and levosimendan seem to be promising cardioprotective agents, but large trials are still needed to assess the best cardioprotective agent(s) and optimal protocol(s). The aim of monitoring is early detection and assessment of mechanisms of perioperative cardiovascular dysfunction. Ideally, volume status should be assessed by 'dynamic' measurement of haemodynamic parameters. Assess heart function first by echocardiography, then using a pulmonary artery catheter (especially in right heart dysfunction). If volaemia and heart function are in the normal range, cardiovascular dysfunction is very likely related to vascular dysfunction. In treating myocardial dysfunction, consider the following options, either alone or in combination: low-to-moderate doses of dobutamine and epinephrine, milrinone or levosimendan. In vasoplegia-induced hypotension, use norepinephrine to maintain adequate perfusion pressure. Exclude hypovolaemia in patients under vasopressors, through repeated volume assessments. Optimal perioperative use of inotropes/vasopressors in cardiosurgery remains controversial, and further large multinational studies are needed. Cardiosurgical perioperative classification of cardiac impairment should be based on time of occurrence (precardiotomy, failure to wean, postcardiotomy) and haemodynamic severity of the patient's condition (crash and burn, deteriorating fast, stable but inotrope dependent). In heart dysfunction with suspected coronary hypoperfusion, an intra-aortic balloon pump is highly recommended. A ventricular assist device should be considered before end organ dysfunction becomes evident. Extra-corporeal membrane oxygenation is an elegant solution as a bridge to recovery and/or decision making. This paper offers practical recommendations for management of perioperative HF in cardiosurgery based on European experts' opinion. It also emphasizes the need for large surveys and studies to assess the optimal way to manage perioperative HF in cardiac surgery.
Mots-clé
Coronary-Artery-Bypass, Central Venous-Pressure, Capillary Wedge Pressure, Aortic-Valve-Replacement, Calcium Sensitizer Levosimendan, Intrathoracic Blood Volumes, Brain Natriuretic Peptide, Predict Operative Risk, Low-Output Syndrome, One-Year Mortality
Pubmed
Web of science
Open Access
Oui
Création de la notice
01/07/2010 14:51
Dernière modification de la notice
20/08/2019 12:33
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