Postoperative complications of patients undergoing cardiac surgery.

PURPOSE OF REVIEW: Cardiac surgery is at high risk for the development of postoperative complications involving cardiovascular and respiratory system, as well as kidneys and central nervous system. The aim of this review is to provide an overview on the most recent findings concerning the type and incidence of different complications after cardiac surgery and to summarize the current recommendations.

RECENT FINDINGS: Despite an improvement of surgical and anaesthesia techniques that resulted in a significant decrease in mortality, postoperative complications play a major role in affecting morbidity, mortality, length of hospital stay and patients' quality of life. The most recent evidence suggests that fluid and inotropes administration should be targeted to maintain a cardiac index above 3 l/min/m throughout the perioperative period. Volatile anaesthesia and mechanical ventilation with low tidal volumes, low driving pressure and moderate-low positive end-expiratory pressure should be preferred. Preoperative steroids could reduce postoperative atrial fibrillation, whereas no drug has shown to effectively prevent kidney injury.

SUMMARY: Cardiac surgery is still at high risk for postoperative complications. The optimal type of anaesthesia, protective mechanical ventilation during and after surgery as well as haemodynamic management with vasoactive and inotropic drugs is still to be determined.