The End Organ Protection in Cardiac Surgery

Mortality and morbidity post cardiac surgery with cardiopulmonary bypass (CPB) remain relative stable over the last decades, while the number of patients with increased co-morbidity and more complex cardiac disease increases. Nevertheless end organ dysfunction and/or failure remain an issue. Multiple peri-operative variables, such as non optimal oxygen delivery, manipulation of the aorta, hyperlactatemia, type of anesthesia, surgical procedure and myocardial protection can be hold responsible for end organ failure post cardiac surgery. However, it becomes more and more evident that also pre-existing factors, such as metabolic syndrome, renal insufficiency, hypertension, stroke and infection exacerbate mortality and morbidity. Unfortunately these predisposing risk factors cannot be influenced peri-operative. Therefore therapy should focus on controlling peri-operative variables that in combination with the predisposing factors will further exacerbate organ dysfunction. In order to achieve this more emphasis should be given to a patient specific, goal directed approach perfusion approach.