Bolling S F, Dickstein M L, Levy J H, McCarthy P M, Oz M C, Savage R M
University of Michigan, Ann Arbor, USA.
Heart Surg Forum. 2000;3(4):337-49.
Surgical heart failure management is the fastest growing aspect of cardio-vascular surgery. Advances in cardiac surgical techniques have changed the number and types of operations permitted physicians and thus broadened the complexity of patients recommended for operation.
Surgeons, anesthesiologists and cardiologists face hemodynamic and patho-physiological challenges that can be optimally overcome only by modifying treatment strategies. Because many treatment standards are still evolving in this rapidly advancing field, a team of cardiovascular surgeons and anesthesiologists convened to share clinical experience and impressions and discuss practical issues related to high-risk patients undergoing heart surgery.
Heart failure pathophysiology, surgical heart failure management, including mitral reconstruction and left ventricular remodeling, cardiopulmonary bypass weaning, inotropic support, transesophageal echocardiography and acute cardiovascular collapse after cardiac surgery are discussed.
This article is intended to guide clinicians to improve patient care and outcomes in this special population by providing specific guidance on the appropriate use of inotropic and mechanical support in patients undergoing high-risk procedures using innovative techniques.
外科心力衰竭管理是心血管外科领域中发展最为迅速的方面。心脏外科技术的进步改变了医生可开展的手术数量和类型，从而扩大了建议接受手术治疗的患者群体的复杂性。
外科医生、麻醉医生和心脏病专家面临着血流动力学和病理生理学方面的挑战，只有通过调整治疗策略才能最佳地克服这些挑战。由于在这个快速发展的领域中许多治疗标准仍在不断演变，一组心血管外科医生和麻醉医生齐聚一堂，分享临床经验和看法，并讨论与接受心脏手术的高危患者相关的实际问题。
讨论了心力衰竭的病理生理学、外科心力衰竭管理，包括二尖瓣重建和左心室重塑、体外循环脱机、正性肌力支持、经食管超声心动图以及心脏手术后的急性心血管衰竭。
本文旨在通过针对使用创新技术进行高危手术的患者合理使用正性肌力和机械支持提供具体指导，引导临床医生改善这一特殊人群的患者护理和治疗效果。
