Cardiac Surgery – Adult Acquired
Adult acquired cardiac surgery tests whether you can connect presentation, imaging and operative risk to a defensible operation. Coronary, valve, aortic and pericardial problems must be managed by established indications, not by isolated numbers.
Core rules
- CABG is preferred in multivessel disease with diabetes, left main stenosis or complex anatomy; use a heart-team and SYNTAX reasoning.
- Symptomatic severe aortic stenosis or stenosis with LV dysfunction is an indication for valve replacement; choose SAVR versus TAVI by age, anatomy, frailty and access.
- Type A aortic dissection is a surgical emergency; uncomplicated type B dissection is usually managed medically first.
- Pericardial tamponade is a clinical and echocardiographic diagnosis; drainage is urgent, but unstable patients may need it before full imaging.
Worked example
A 64-year-old diabetic with three-vessel disease, proximal LAD and RCA disease, EF 45% and moderate functional MR needs revascularization for prognosis. CABG is favored over PCI because of diabetes and multivessel complexity. Moderate functional MR often improves after revascularization; add mitral repair if the valve is structurally repairable or MR is severe. The marks come from staged reasoning, not from listing operations.
Traps
Do not offer isolated PCI for left main disease without heart-team input; do not delay type A dissection repair for CT in an unstable patient; do not label every effusion as tamponade; do not ignore renal function and frailty when selecting TAVI.