الفهرس 
Heart Diseases and Their Surgical ManagementOnly 14 pages are availabe for public view
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Abstract
Cardiovascular surgery is a surgery on the heart or great vessels done to treat complications
of ischemic heart disease (for example, coronary artery bypass grafting), correct congenital heart
disease, or treat valvular heart disease from various causes including endocarditis, rheumatic
heart disease and atherosclerosis.
Prophylactic intravenous antibiotics should be routinely administered to patients
undergoing cardiac surgery and the use of antimicrobials for cardiovascular surgical infection
prophylaxis is considered the standard of care, with the goal of preventing surgical site infections
such as wound infection, mediastinitis, and endocarditis.
There is general consensus that postoperative prophylactic antibiotics should be stopped
within 24 hours of most major surgical procedures. However, results of studies on the general
surgical population do not directly apply to cardiac surgery.
The most obvious reason is the fact that cardiopulmonary bypass is used in cardiac surgery.
Cardiopulmonary bypass used in cardiac surgery is a nonphysiological assisting device, the pump
itself is associated with a broad array of adverse physiologic sequelae that predispose cardiac
surgery patients to infectious complications. Cardiopulmonary bypass is known to compromise
humoral immunologic defenses, reduce phagocytosis, and activate white blood cells, all of which
impair the ability to neutralize infectious organisms.
The often-used systemic hypothermia is associated with increased surgical site infection
and it has profound effects on the volume of distribution, and elimination kinetics of a variety of
drugs including the commonly used prophylactic antibiotics such as cephalosporin, vancomycin
and aminoglycosides.
The length of a surgical procedure is also generally correlated with the risk of
postoperative infection. Cardiac surgical procedures routinely require 3 to 4 hours for
completion, thereby placing patients at increased infectious risk. In addition, cardiac surgery
patients invariably leave the operating room with indwelling chest catheters that have the
potential to serve as external routes for bacterial entry.