Our Summary

Heart surgeries carry a high risk of death, which makes it crucial to carefully choose who should undergo these procedures. This is where risk scores come into play. They help doctors decide who can safely have surgery by predicting the patient’s chances of complications or death. Two of the most used risk scores are the European System for Cardiac Operative Risk Evaluation Score and the Society of Thoracic Surgeons score. But, these aren’t the only ones, and none of them are perfect. So, there’s a need for more research to develop a better scoring system. This paper reviews the strengths and weaknesses of the most popular scoring systems to figure out what a better system might look like. This will include looking at how well the scores can be applied to different people, how easy they are to use, and how accurately they predict outcomes.

FAQs

  1. What is the purpose of risk scores in cardiac surgery?
  2. What are the two most commonly used risk scores in cardiac surgery?
  3. Why is there a need for more research in developing a better cardiac surgery scoring system?

Doctor’s Tip

In addition to choosing the right surgeon and hospital for your cardiac surgery, it is important to follow all pre-operative instructions given to you by your healthcare team. This may include stopping certain medications, fasting before the surgery, and quitting smoking. Following these instructions can help reduce the risk of complications during and after surgery. It is also important to communicate openly with your healthcare team about any concerns or questions you may have. Remember, your healthcare team is there to support you and help you through this process.

Suitable For

Typically, patients who are recommended for cardiac surgery are those with severe coronary artery disease, valvular heart disease, congenital heart defects, or other structural heart issues that cannot be managed effectively with medications or other less invasive treatments. These patients may be experiencing symptoms such as chest pain, shortness of breath, fatigue, or palpitations that significantly impact their quality of life. Additionally, patients with a high risk of heart attack or sudden cardiac death may also be recommended for surgery to reduce their risk of complications.

It is important for patients to undergo a thorough evaluation by a cardiac surgeon and other members of the healthcare team to determine if they are suitable candidates for surgery. Factors such as age, overall health, presence of other medical conditions, and the complexity of the surgical procedure needed will all be taken into consideration when making this decision. Ultimately, the goal of cardiac surgery is to improve the patient’s heart function, alleviate symptoms, and reduce the risk of complications and death associated with their heart condition.

Timeline

Before cardiac surgery:

  1. Patient is evaluated by a cardiologist and other specialists to determine the need for surgery and assess the risks involved.
  2. Preoperative tests and assessments are conducted, including blood tests, imaging tests, and a thorough medical history review.
  3. Patient receives instructions on preoperative preparations, such as fasting before surgery, stopping certain medications, and other necessary precautions.
  4. Patient may undergo a preoperative cardiac rehabilitation program to optimize their physical condition before surgery.

After cardiac surgery:

  1. Patient is closely monitored in the intensive care unit (ICU) immediately following surgery for any complications.
  2. Pain management and medication are provided to manage discomfort and prevent infection.
  3. Physical therapy and rehabilitation programs are initiated to aid in recovery and improve mobility.
  4. Follow-up appointments with the surgical team and cardiologist are scheduled to monitor progress and address any concerns.
  5. Long-term lifestyle changes, such as a healthy diet, exercise, and medication adherence, are recommended to maintain heart health and prevent further complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cardiac surgery include:

  1. What specific type of cardiac surgery do I need and why?
  2. What are the potential risks and benefits of the surgery for my particular case?
  3. How experienced are you and the surgical team in performing this type of surgery?
  4. What is your success rate with this type of surgery?
  5. What is the recovery process like and how long will it take?
  6. What are the potential complications or side effects of the surgery?
  7. How will my overall health and medical history affect the success of the surgery?
  8. Are there any alternative treatments or procedures that could be considered?
  9. What kind of post-operative care will I need and how long will it last?
  10. What is the long-term outlook for my heart health after the surgery?

Reference

Authors: Pittams AP, Iddawela S, Zaidi S, Tyson N, Harky A. Journal: J Cardiothorac Vasc Anesth. 2022 Apr;36(4):1148-1156. doi: 10.1053/j.jvca.2021.03.005. Epub 2021 Mar 6. PMID: 33836964