[General surgical interventions in heart surgery patients].

Due to the rapid development in cardiac surgery it is obvious that we now find more patients after heart operations requiring major noncardiac surgery. Knowledge concerning the special problems in treatment of patients with prior cardiac surgery is indispensable to guarantee a low perioperative risk. It is of great consequence, what kind of cardiac disease we are dealing with, whether the cardiac defect could be corrected partially or totally and how the cardiac index has been finally. We discuss the situation after different cardiac operations including coronary bypass grafting, heart valve surgery and heart transplantation. Several multi-case studies could prove that after successfully performed bypass grafting a coronary heart disease does not improve the perioperative risk of following surgical treatment. Some authors recommend a 6 month interval after coronary heart surgery. A higher risk for ventricular arrhythmias can be found in patients with a manifest coronary heart disease following operative revascularisation. Special comment is given to the recommended treatment of the different stages of coronary heart disease in respect to the time course with noncardiac surgery. General surgery after heart valve replacement can be complicated by the appearance of dysrhythmia and arrhythmia, left heart failure, tendency to bleed and higher risk of infections. Patients with a transplanted heart need special care on the part of narcosis and asepsis.