The Surgical clinics of North America
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Thoracic great vessel and cardiac trauma are characterized by anatomic location and mechanism of injury: blunt or penetrating. Management strategies are also directed by the extent and mechanism of injury. ⋯ Given the increasing sophistication of these technologies and the demonstrated usefulness of a disease-oriented approach toward patient management, trauma centers have adopted a multidisciplinary team model for management of multitrauma victims. In this review, the authors detail the diagnosis and management of blunt aortic, nonaortic great vessel, blunt cardiac, and penetrating cardiac injuries.
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Cardiovascular complications are infrequent but can result in significant morbidity following noncardiac surgery, especially in patients with peripheral vascular disease or increased age. All patients require some level of preoperative screening to identify and minimize immediate and future risk, with a careful focus on known coronary artery disease or risks for coronary artery disease and functional capacity. The 2007 American College of Cardiology/American Heart Association Guidelines are clear that noninvasive and invasive testing should be limited to circumstances in which results will clearly affect patient management or in which testing would otherwise be indicated. beta-Blocker therapy has become controversial in light of recent publications but should be continued in patients already on therapy, and started in patients with high cardiac risk undergoing intermediate- or high-risk surgery.
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Surg. Clin. North Am. · Aug 2009
ReviewCardiopulmonary bypass/extracorporeal membrane oxygenation/left heart bypass: indications, techniques, and complications.
Cardiopulmonary bypass has revolutionized the ability to provide cardiorespiratory support and has advanced the field of cardiac surgery. This invention has given surgeons the ability to perform many procedures that were not possible previously. ⋯ Cardiopulmonary bypass, extracorporeal membrane oxygenation, and left heart bypass have revolutionized our ability to operate on the heart, great vessels, and aorta in addition to providing means of short-term support for reversible causes of cardiac and/or respiratory failure. The success of these approaches is dependent upon excellent communication between the surgeon, perfusionist, and anesthesiologist as well as constant vigilance and troubleshooting by the caregivers.