Management of the Cardiac Patient Requiring Major Surgery

IT IS widely appreciated that the risk of death for cardiac patients undergoing ma- jor surgery is considerably less today than was the case 50 years ago. Greater surgical skill and improved cardiac management deserve much credit for this decrease in mor- tality. Of perhaps equal importance, however, have been the contributions from other areas. These include advances in anesthesia, the development of adequate blood bank fa- cilities, improved understanding of fluid and electrolyte balance, and the effective use of chemotherapeutic agents. Finally, the fact that patients with clinical coronary artery disease can undergo major surgery with an additional mortality hazard of less than 4 per cent'-3 reflects the value of attention to small details and of the institution of specific precautions to forestall catastrophe before, during, and following surgery.