The Dreaded Bring Backs

Abstract

The postoperative care of the cardiac surgical patient continues to be an ongoing challenge. An aging population coupled with increasing comorbidities results in sicker patients now undergoing open-heart surgery. Moreover, those patients with high operative risk are undergoing minimally invasive cardiac procedures that are associated with their own newly recognized inherent risks. Anesthesiologists and intensivists caring for cardiac surgical patients should be aware of the challenges imposed by the population and by the procedures. Their scope of skills should expand to encompass fluency in bedside echocardiography, electrophysiology, and bedside extracorporeal and balloon pump insertion techniques. In so doing, cardiac anesthesiologists/intensivists not only will be able to make critical abstract plans that are implemented by other personnel, but also will be able to pursue lifesaving prompt diagnostic and therapeutic procedures frequently needed in this acutely critically ill patient population. This chapter discusses some of the frequently encountered life-threatening complications that occur in the postoperative cardiac surgical patient that may lead to surgical reexploration. The chapter focus is on the definitive and supportive management of these complications and their underlying mechanisms with more specific attention on postoperative bleeding and coagulopathy.