Preoperative investigations of open heart surgical patients: our current institutional protocol (1)

Abstract

Background: Open heart surgery is one of the complex procedures physicians undertake in modern medicine. It requires high tech equipment, special infrastructure and highly skilled manpower, especially in the areas of cardiology, cardiac surgery, anaesthesiology and cardiac perfusion. Preoperative diagnosis must be accurate and patients’ safety determined in order that appropriate informed consent is given. In open heart surgery, our institution developed preoperative assessment protocol. They are clinical evaluation and preoperative investigations.

The objective of this study is to highlight our institutional preoperative investigative protocol and compare same with what is available in the literature.

Materials and Method: In our institution, the first open heart surgery was done in 1974. We performed a retrospective review of the preoperative investigation protocols from 1974 to 2016, spanning a period of 42 years noting the changes and outcome of the changes. The 42 years of cardiac surgery activity occurred in 3 phases: 1. from 1974 – 2000; 2. 2003; 3. 2013 – 2016. Data were obtained from our hospital Record Department. The types of the preoperative investigative protocol and outcome of the changes were analyzed using Microsoft excel and results expressed in arithmetic percentages and presented in tables and bar chart.

Results: These investigations are broadly divided into diagnostic and patient’s fitness assessment investigations. The diagnostic investigations aid proper clinical evaluations and are used in evaluating congenital heart defects and acquired heart diseases. In addition, fitness assessment tests have two functions and they are 1. determining the risks of postoperative morbidity and mortality from patients’ co-morbidities and the systemic effects of the cardiac disease(s). 2. Predicting the postoperative support that may be required in order to maximize the chances of uneventful surgery. The diagnostic and fitness investigations guide the quartet (cardiologist, cardiac surgeon, cardiac anaesthetist and cardiac perfusionist) in making appropriate management decisions especially with regard to complex congenital heart defects and complex cardiac cases in the elderly, discussed in the setting of cardiac team meetings.

Conclusion: Preoperative investigations form part of an intrinsic preoperative checklist to ensure where possible uneventful surgery. When they are holistically done and accurate diagnosis is made including patients properly worked up via-a-vis the results of the investigations, the outcome is bound to be favourable.

Keywords: complex, congenital, diagnostic, preoperative, investigation