Robert M. Bojar, MD, Chief of Cardiothoracic Surgery, Saint Vincent Hospital, Worcester, MA, USA

Preface ix

Acknowledgments xi

1. Synopsis of Adult Cardiac Surgical Disease 1

2. Diagnostic Techniques in Cardiac Surgery 121

3. General Preoperative Considerations and Preparation of the Patient for Surgery 173

4. Cardiac Anesthesia 217

5. Cardiopulmonary Bypass 283

6. Myocardial Protection 323

7. Admission to the ICU and Monitoring Techniques 341

8. Early Postoperative Care 363

9. Mediastinal Bleeding 417

10. Respiratory Management 457

11. Cardiovascular Management 513

12. Fluid Management, Renal, Metabolic, and Endocrine Problems 673

13. Post-ICU Care and Other Complications 737

Appendices 843

Appendix 1A American College of Cardiology Classes of Recommendation and Levels of Evidence 845

Appendix 1B New York Heart Association Functional Classification 845

Appendix 1C The Canadian Cardiovascular Society Classification for Grading of Angina 846

Appendix 1D Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profiles of Advanced Heart Failure 847

Appendix 2 Typical Preoperative Order Sheet 848

Appendix 3 Cardiac Surgery Preoperative Assessment Checklist 850

Appendix 4 Typical Orders for Admission to the ICU 851

Appendix 5 Typical Transfer Orders from the ICU 854

Appendix 6 Hyperglycemia Protocol for Cardiac Surgery Patients 857

Appendix 7 Heparinization Protocol for Cardiac Surgery Patients 859

Appendix 8 Protocol for Initiating Warfarin 860

Appendix 9 INR Reversal Protocol 861

Appendix 10A The CHA2DS2-VASc Score 862

Appendix 10B The HAS-BLED Score 863

Appendix 11 Drug, Food, and Dietary Supplement Interactions with Warfarin 864

Appendix 12 Doses of Parenteral Medications Commonly Used in the ICU and Their Modifications in Renal Failure 865

Appendix 13 Doses of Nonparenteral Drugs Commonly Used After Heart Surgery and Their Modifications in Renal Failure 868

Appendix 14 Definitions from the STS Data Specifications (Version 4.20 2020) 874

Appendix 15 Body Surface Area Nomogram 879

Appendix 16 Body Mass Index Chart 880

Appendix 17 Aortic Size Index for Thoracic Aneurysms 881

Appendix 18 Aortic Height Index for Thoracic Aneurysms 882

Appendix 19 Aortic Height and Length Index for Thoracic Aneurysms 883

Appendix 20 Technique of Thoracentesis 884

Appendix 21 Technique for Tube Thoracostomy 885

Index 887