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Perioperative management of the high-risk surgical patient: cardiac surgery 

Perioperative management of the high-risk surgical patient: cardiac surgery
Perioperative management of the high-risk surgical patient: cardiac surgery

Marco Ranucci

, Serenella Castelvecchio

, and Andrea Ballotta



Minor updates throughout the text

References updated

Updated on 22 February 2018. The previous version of this content can be found here.
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date: 14 July 2020

During the last decade, as a result of continually improving surgical strategy and the technology which supports it (e.g. anaesthesia), cardiac surgery is offered to patients with advanced age and those with increasingly complex co-existing conditions that were previously considered to be contraindications. In addition, an increasing number of patients have previously undergone angioplasty, thereby delaying their initial coronary artery bypass graft surgery to a more advanced age. In general, candidates for cardiac surgery may now be not only older than in the past, but also more likely to have health problems such as hypertension and diabetes. Risk stratification may help to identify ‘the’ high-risk patient: ‘pre-warned is pre-armed’. In high-risk cardiac surgery patients, the surgical treatment options and perioperative care must be tailored to each patient, in order to optimize the benefits and minimize the risk of detrimental effects. The preoperative anticoagulation practice is an important aspect, balancing the risk between ischaemic and bleeding complications. New antiplatelet agents and oral anticoagulants have been recently delivered, and their role in patients scheduled for heart surgery is an additional important issue.

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