Sixth Edition
Robert M. Bojar, MD
Chief of Cardiothoracic Surgery
Saint Vincent Hospital
Worcester, Massachusetts, USA
This edition first published 2021
© 2021 John Wiley & Sons Ltd
Edition History
Robert M. Bojar (5e, 2011)
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Library of Congress Cataloging‐in‐Publication Data
Names: Bojar, Robert M., 1951– author.
Title: Manual of perioperative care in adult cardiac surgery / Robert M.Bojar.
Description: Sixth edition. | Hoboken, NJ : Wiley‐Blackwell, 2020. | Includes bibliographical references and index.
Identifiers: LCCN 2020029687 | ISBN 9781119582557 (paperback) | ISBN 9781119582595 (adobe pdf) | ISBN 9781119582588 (epub)
Subjects: MESH: Cardiac Surgical Procedures | Perioperative Care–methods | Outline
Classification: LCC RD598 | NLM WG 18.2 | DDC 617.4/12–dc23
LC record available at https://lccn.loc.gov/2020029687
Cover Design: Wiley
Cover Image: © Jackie Niam/Getty Images
In loving memory of my parents, who devoted their lives
to helping others and inspired me to do the same.
Cardiac surgery has faced several challenges in this century. Advances in coronary stenting have allowed most patients with coronary disease to undergo percutaneous coronary intervention. This seems to leave only patients with nonstentable disease or failed stents for the surgeon. Transcatheter aortic valve replacements (TAVRs) have been performed more commonly than surgical AVRs for several years, and transcatheter mitral valve technology continues to evolve and should see wider applications. Descending thoracic aortic surgery has been all but replaced by endovascular stent grafting. Electrophysiologists have become more aggressive in ablating arrhythmias. Most of these technologies have evolved from the concept that a less invasive approach to treating structural heart disease is preferred by patients to reduce trauma, minimize complications, expedite recovery, and improve the quality of life – and this concept has become reality.
Although these approaches may be applicable to patients at both ends of the clinical spectrum, surgery will still remain the best approach for many patients, and invariably will require the use of cardiopulmonary bypass with its inherent morbidity. There is little doubt that surgical patient acuity will continue to increase, and excellence in perioperative care will remain essential to optimize outcomes, both for patients undergoing open‐heart surgery and for the higher‐risk patients undergoing transcatheter approaches.
The sixth edition of the Manual incorporates some of the newer guidelines, medications, and concepts that have evolved over the past nine years since the publication of the last edition. I have retained important references and added more current ones if they add new information. Online access to virtually all references should be available to the reader no matter how obscure the source may appear. I encourage the reader to review updated guidelines from the American College of Cardiology Foundation, the European Society of Cardiology, and the Society of Thoracic Surgeons as they become available online. As always, I am hopeful that this edition will provide a comprehensive, up‐to‐date review that will assist healthcare providers in delivering the best possible care to their cardiac surgical patients.
Cardiac surgery requires meticulous attention to detail to ensure the best possible outcomes. Decision‐making in the perioperative period involves close cooperation and communication among all members of the healthcare team, including cardiac surgeons, anesthesiologists, cardiologists, physician assistants, nurse practitioners, perfusionists, respiratory therapists, and critical care and floor nurses. Identifying problems and seeking consultations with experts in other fields is important to optimize perioperative care. I am greatly appreciative of the efforts of many individuals who set aside valuable time to review sections of the manuscript in their areas of expertise. I would like to acknowledge the critiques and comments of Drs. Joseph Hannan, Arie Farji‐Cisneros, Dharmender Chandok, Suzanne Martin, Rachel Kaplan, and Fady Marmoush. I would also like to thank Philip Carpino, PA‐C, Bettina Alpert, CCP, Joshua Deisenroth, PA‐C, and Wanda Reynolds, CCRT, for their reviews and suggestions. Lastly, I am indebted to my Chief Physician Assistant, Theresa Phillips, PA‐C, who helps coordinate the care my patients receive, and who reviewed many sections of the manuscript to ensure their accuracy.
Notice: The indications and dosages of all drugs in this book have been recommended in the medical literature and conform to the practices of the general community. The medications described do not necessarily have specific approval by the Food and Drug Administration for use in the diseases and dosages for which they are recommended. The package insert for each drug should be consulted for use and dosage as approved by the FDA. Because standards for usage change, it is advisable to keep abreast of revised recommendations, particularly those concerning new drugs. Although the author has made every attempt to ensure the accuracy of drug dosages, it is the obligation of the reader to confirm drug dosages prior to prescribing any drug.
Abbreviations used through this book are typeset and easy to read. However, many hospitals have lists of approved abbreviations which initially were mandated to avoid medication errors caused by inability to interpret handwriting. Use of these abbreviations with computerized order writing within electronic medical records is recommended to avoid this problem.
