Anesthesia and the cardiac patient

Since the first cardiac surgical procedure was performed 50 years ago, the practice of cardiac surgery, and therefore of cardiac anesthesiology, has evolved continually. It may seem that anesthesia for elective coronary artery bypass graft (CABG) surgery is routine now, although cardiac surgeons and anesthesiologists would agree that patients are substantially “older and sicker” than they were a decade ago. Furthermore, adult patients with end-stage heart failure, complex valvular lesions, and congenital heart disease are now seen commonly in the cardiac operating room. These realities have stimulated changes in anesthetic management and ongoing research efforts to ensure further improvements.

In this issue of Anesthesiology Clinics of North America, the first seven articles deal with these changes and with state-of-the-art knowledge in 2003, which is relevant to any cardiac surgical procedure. The eighth article summarizes the invaluable contribution of intraoperative transesophageal echocardiography in changing the anesthesiologists' and surgeons' approaches to valvular heart surgery. The next three articles deal with recently developed procedures, devices, and settings: off-pump coronary surgery, current ventricular assist devices, and innovative procedures in the cardiac catheterization laboratory. The twelfth article deals with a new and growing group of patients, those with corrected or palliated congenital heart disease who have attained adulthood. The final article deals with another growing surgical group—women. Because women outlive men by 5–7 years, with an average life expectancy of approximately 80 years, aggressive treatment of cardiovascular disease in older and sicker women is becoming the norm, as it should be.

In choosing these topics, we have avoided the mundane. This issue of the Clinics was not meant to be an overview of the entire discipline of cardiac anesthesiology, but rather a careful contemplation of several relevant yet complex topics of current interest in the field. The authors are acknowledged experts and have performed admirably in distilling extensive knowledge and unresolved controversies into succinct summaries. It is our sincere hope that the readers find useful information for their practice and be stimulated to pursue further inquiry into certain topics.

My heartfelt thanks go first and foremost to each of the contributing authors for their willingness to share their expertise and the subsequent time and effort required to communicate their insights so well. I also owe a great debt to the editorial staff at the Texas Heart Institute (Marianne Mallia, Virginia Fairchild, Jude Richard, and Chrissie Chambers), who edited each article to perfect the language. I also thank Dr. Lee A. Fleisher, Consulting Editor, for extending the invitation to me to be Guest Editor for this issue. Finally, I would like to thank Mr. Bob Gardler of Elsevier for his patience and persistence in seeing each article to completion.