Table Of Contents

Valve Replacement Surgical Indications

Symptomatic because of severe valve damage = Replace

Condition	Indications for Surgery
Aortic Stenosis	🔷 Symptoms of stenosis (SAD)
🔸 Syncope, angina, dyspnea from heart failure
🔷 Asymptomatic with LVEF <50%
Aortic Insufficiency	🔷 Symptomatic patients with severe aortic regurgitation
🔷 Asymptomatic patients with cardiomegaly or left ventricular ejection fraction (LVEF) ≤ 55%
🔷 Patients with aortic regurgitation undergoing CABG, surgery of the ascending aorta, or another valve surgery
Mitral Stenosis	🔷 Symptomatic patients
🔷 Patients with a mitral valve area <1.5 cm² (may be a candidate for percutaneous balloon commissurotomy)
Mitral Regurgitation (MR)	🔷 Symptomatic patients (e.g., dyspnea on exertion)
🔷 EF < 60%
🔷 Acute onset of MR

<aside> 🚨

All patients with acute primary MR should undergo urgent surgical repair or valve replacement.

</aside>

High-Yield Coronary Artery Bypass Grafting (CABG)

Post-CABG Atrial fibrillation

Occurs in 15%–40% of patients within a few days post-CABG.
Typically self-limited, resolving in <24 hours.
Best managed with beta-blockers or amiodarone for rate control.

Post-CABG Acute mediastinitis

Can occur post-cardiac surgery.
Presents with fever, chest pain, leukocytosis, and mediastinal widening on chest x-ray.
Requires drainage, surgical debridement, and prolonged antibiotic therapy.

Post-CABG Pleural effusions

Occur in almost 50% of CABG patients.
Post-cardiac surgery pleural effusions can be managed conservatively if they
- Are small to moderate in size and not enlarging.
- Have an early onset (postoperative day 1 or 2).
- Are not associated with respiratory symptoms.

Post-Cardiac Injury Syndrome (PCIS)

Definition

PCIS results from immune-complex deposition in the pericardium and pleura following cardiac events or interventions (e.g., CABG, myocardial infarction, PCI).