COMPLICATIONS OF CARDIAC SURGERY

1. COMPLICATIONS OF CARDIAC
SURGERY
Prepared by:-
2-Mustafa Flayyih Abd

2. A- Decrease cardiac output
1-(Hypovolemia)
2 Bleeding
3- Cardiac Tamponade
4- Fluid overload
5-Hypothemia
6-Hypertension
7-Tachydysrhythmias
8-Bradycardias
9-Cardiac Failure
10-Mayocardial Infarction
B -Pulmonary Complications:-
C - Neurologic change and Stroke
D - Renal Failure and Electrolyte
Imbalance:-
1- Acute Renal Failure
2-Electolyte Imbalance
E - Other complications :-
1-Hepatic Failure
2- Infection

3. Decreased Cardiac Output
•Hypovolemia (most common cause of decreased
cardiac output after cardiac surgery)

4. CAUSES
• Net loss of blood and intravascular volume.
• Surgical hypothermia (as the reduced body temperature rises after
surgery, blood vessels dilate, and more volume is needed to fill the
vessels).
• Intravenous fluid loss to the interstitial spaces because surgery and
anesthesia increase capillary permeability.

5. Assessment and Management
• Arterial hypotension, tachycardia, low central venous pressure (CVP)
and low pulmonary artery wedge pressure (PAWP) are often seen.
• Fluid replacement may be prescribed. Replacement fluids include
colloid (albumin, hetastarch), packed red blood cells, or crystalloid
solution (normal saline, lactated Ringer’s solution).

6. Persistent bleeding

7. Causes
• Cardiopulmonary bypass causes platelet dysfunction, and
hypothermia alters clotting mechanisms.
• Surgical trauma causes tissues and blood vessels to ooze bloody
drainage.
• Intraoperative anticoagulant (heparin) therapy.
• Postoperative coagulopathy may also result from liver dysfunction
and depletion of clotting components.

8. Assessment and Management
• Accurate measurement of wound bleeding and chest tube blood is
essential. Drainage should not exceed 200 mL/h for the first 4 to 6
hours. Drainage should decrease and stop within a few days.
• Serial hemoglobin, hematocrit, and coagulation studies are
performed to guide therapy.
• Administration of fluids, colloids, and blood products: packed red
blood cells, fresh frozen plasma, platelet concentrate.
• Protamine sulfate may be administered to neutralize unfractionated
heparin.
• Administration of desmopressin acetate (DDAVP) to enhance
platelet function.
• If bleeding persists, the patient may return to the operating room.

9. Cardiac Tamponade

10. Causes
•Fluid and clots accumulate in the pericardial
sac, which compress the heart, preventing
blood from filling the ventricles.

11. Assessment and Management
• Signs and symptoms include arterial hypotension, tachycardia,
muffled heart sounds, decreased urine output, and c CVP. Arterial
pressure waveform may show pulsus paradoxus (decrease of more
than 10 mm Hg systolic blood pressure during inspiration).
• The chest drainage system is checked to eliminate possible kinks or
obstructions in the tubing.
• Chest x-ray may show a widening mediastinum.
• Emergency medical management is required; may include return to
surgery.

13. pulsus paradoxus

14. Fluid overload
• Intravenous (IV) fluids and blood products increase
circulating volume.

15. Assessment and Management
• High CVP and pulmonary artery pressures as well as crackles
indicate fluid overload.
• Diuretics are prescribed and the rate of IV fluid administration is
reduced.
• Alternative treatments include continuous renal replacement
therapy and dialysis.
• Patient is rewarmed gradually after surgery, decreasing
vasoconstriction.

16. Hypothermia
•Low body temperature leads to vasoconstriction,
shivering, and arterial hypertension.

17. Assessment and Management
• Patient is rewarmed gradually after surgery,
decreasing vasoconstriction.

18. Hypertension
• Results from postoperative vasoconstriction. It may
stretch suture lines and cause postoperative
bleeding. The condition is usually transient.

19. Assessment and Management
• Vasodilators (nitroglycerin [Tridil], nitroprusside
[Nipride]) may be used to treat hypertension.
• Administer cautiously to avoid hypotension.

20. Tachydysrhythmias
•Increased heart rate is common with
perioperative volume changes. Uncontrolled
atrial fibrillation commonly occurs during the
first few days postoperatively.

21. Assessment and Management
• If a tachydysrhythmia is the primary problem, the heart rhythm is
assessed and medications (eg, amiodarone [Cordarone], diltiazem
[Cardizem], may be prescribed.
• Antidysrhythmic agents may be given before coronary artery bypass
graft (CABG) to minimize the risk of postoperative
tachydysrhythmias.
• Carotid massage may be performed by a physician to assist with
diagnosing or treating the dysrhythmia.
• Cardioversion and defibrillation are alternatives for symptomatic
tachydysrhythmias.

22. Bradycardias
• Decreased heart rate due to surgical trauma and
edema affecting the cardiac conduction system.

24. Assessment and Management
• Many postoperative patients have temporary pacer
wires that can be attached to a pulse generator
(pacemaker) to stimulate the heart to beat faster.
Less commonly, atropine or other medications may
be used to increase heart rate.

25. Cardiac failure
• Myocardial contractility may be decreased
perioperatively.

27. Assessment and Management
• The nurse observes for and reports signs of heart
failure including hypotension, c CVP, c PAWP, venous
distention; labored respirations; and edema.
• Medical management includes diuretics, digoxin,
and IV inotropic agents.

28. Myocardial infarction (MI) (may occur
intraoperativelyor postoperatively)
• Portion of the cardiac muscle dies; therefore,
contractility decreases. Impaired ventricular wall
motion further decreases cardiac output.
• Symptoms may be masked by the postoperative
surgical discomfort or the anesthesia–analgesia
regimen.

29. Assessment and Management
• Careful assessment to determine the type of pain the
patient is experiencing; MI suspected if the mean
blood pressure is low with normal preload.
• Serial electrocardiograms (ECGs) and cardiac
biomarkers assist in making the diagnosis (alterations
may be due to the surgical intervention).

30. Pulmonary Complications Impaired gas
exchange
• During and after anesthesia, patients require
mechanical assistance to breathe.
• Anesthetic agents stimulate production of mucus
and chest incision pain may decrease the
effectiveness of ventilation.
• Potential for postoperative atelectasis.

31. Assessment and Management
• Pulmonary complications are detected during
assessment of breath sounds, oxygen saturation
levels, arterial blood gases, and ventilator readings.
• Extended periods of mechanical ventilation may be
required while complications are treated.

32. Neurologic Complications Neurologic changes;
stroke
• Thrombi and emboli may cause cerebral infarction and
neurological signs may be evident when patients
recover from anesthesia.

33. Assessment and Management
• Inability to follow simple commands within 6 hours
of recovery from anesthetic; weakness on one side
of body or other neurological changes may indicate
stroke.
• Patients who are elderly or who have renal or
hepatic failure may take longer to recover from
anesthesia.

34. Acute renal failure
• May result from hypoperfusion of the kidneys or
from injury to the renal tubules by nephrotoxic
drugs.

35. Assessment and Management
• May respond to diuretics or may require continuous
renal replacement therapy (CRRT) or dialysis.
• Fluids, electrolytes, and urine output are monitored
frequently.
• Renal failure may become chronic and require
ongoing dialysis.

36. Electrolyte imbalance
• Postoperative imbalances in potassium, magnesium,
sodium, calcium, and blood glucose are related to
surgical losses, metabolic changes, and the
administration of medications and IV fluids.

37. Assessment and Management
• Monitor electrolytes and basic metabolic studies
frequently.
• Implement treatment to correct electrolyte
imbalance promptly

38. Infection
• Surgery and anesthesia alter the patient’s immune
system. Multiple invasive devices used to monitor and
support the patient’s recovery may serve as a source
of infection.

39. Assessment and Management
• Monitor for signs of possible infection: body temperature,
white blood cell and differential counts, incision and puncture
sites, urine (clarity, color, and odor), bilateral breath sounds,
sputum (color, odor, amount).
• Antibiotic therapy may be instituted or modified as necessary.
• Invasive devices are discontinued as soon as they are no
longer required.
• Institutional protocols for maintaining and replacing invasive
lines and devices are followed to minimize the risk of
infection.

40. Hepatic failure
• Surgery and anesthesia stress the liver. Most common
in patients with cirrhosis, hepatitis, or prolonged
right-sided heart failure.

41. Assessment and Management
• Use of medications metabolized by the liver must be
minimized.
• Bilirubin, albumin, and amylase levels are monitored, and
nutritional support is provided.