RT Book, Section
A1 DiSesa, Verdi J.
A2 Cohn, Lawrence H.
SR Print(0)
ID 55925061
T1 Chapter 48. Valvular and Ischemic Heart Disease
T2 Cardiac Surgery in the Adult, 4e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-163310-9
LK accesssurgery.mhmedical.com/content.aspx?aid=55925061
RD 2024/04/19
AB In  recent  years,  there  has  been  a  great  deal  of  progress  in  coronary  artery  surgery,  nonsurgical  treatment  of  coronary  artery  disease,  and  the  surgical  treatment  of  valvular  heart  disease.  As  thoroughly  described  in  previous  chapters,  surgery  on  the  beating  heart  has  become  commonplace.  Interventional  therapies  for  coronary  artery  obstruction  have  extended  to  multivessel  disease  and  continue  to  change  the  number  and  the  nature  of  patients  referred  for  bypass  surgery.  The  options  for  treatment  of  valvular  disease  have  continued  to  expand  with  advances  in  techniques  for  repair  of  aortic  and  mitral  valves,  as  well  as  increases  in  the  choices  of  valve  type  for  replacement.  Techniques  for  aortic  valve  replacement  on  the  beating  heart  via  a  retrograde  transvascular  or  transapical  approach  are  now  under  investigation.  Other  areas  of  rapidly  growing  interest  are  surgical  treatment  of  atrial  arrhythmias  and  the  surgical  approach  to  the  failing  ventricle  in  dilated  ischemic  cardiomyopathy.  Some  of  these  topics  are  discussed  in  other  chapters.  All  are  issues  that  the  surgeon  must  consider  when  planning  a  strategy  for  the  treatment  of  the  patient  with  combined  valvular  and  coronary  artery  disease.  More  patients  are  now  presenting  with  increasingly  complex  pathology.  It  is  less  often  that  the  surgeon  sees  a  patient  with  simple  aortic  stenosis  and  proximal  coronary  artery  disease.  Rather,  that  patient  now  may  have  been  managed  with  more  aggressive  medical  therapy  or  even  catheter  interventions,  and  is  referred  at  an  older  age  and  is  sicker,  with  more  diffuse  disease,  arrhythmias,  and  worsening  ventricular  function.  As  a  result  those  patients  who  present  for  surgery  have  a  higher-risk  profile  than  was  previously  the  case,  and  may  require  a  more  flexible  and  thoughtful  approach.