Preoperative Care of the Pediatric Cardiac Surgical Patient
Jennifer J. Schuette
Alain Fraisse
David L. Wessel
KEY POINTS
Pediatric cardiac intensive care continues to establish itself as an important and necessary subspecialty.
The complexity of heart disease and the expertise necessary to treat these patients require multidisciplinary training and collaborative, integrated care.
Expertise is required for care of premature and full-term newborns, infants, and children, as well as the rapidly growing numbers of adults with long-term survival and continuing need for care of their congenital heart disease (CHD).
Preoperative neurodevelopmental evaluation in patients with CHD should be standard practice, not only to identify those with impairments but also to identify risk factors and strategies to optimize outcome.
Reparative surgery in the newborn is the objective of advanced cardiovascular programs whenever feasible.
Diagnosis is usually based in echocardiography and physical examination, with catheterization reserved for complex cases or interventional procedures.
Adequate resuscitation of preoperative patients is essential to good outcomes.
Balancing single-ventricle physiology and maintaining adequate cardiac output are crucial to achieve preoperative stabilization.
Risk stratification and identification of biologic markers are maturing as useful tool sets to guide therapy and to provide benchmarks for outcomes.
