Planning for Unexpected Complications Can Improve Surgical Outcomes

Ibrahim Sultan, MD

Ibrahim Sultan, MD

Cardiothoracic surgery seldom proceeds precisely as planned. Every patient and every operation bring the potential for surprises, challenges, and complications. With the right kind of forethought and planning, however, surgeons can work through those difficult cases to achieve good outcomes.

“It doesn’t matter how skilled a surgeon you are; patients don’t read the textbooks,” said Ibrahim Sultan, MD, from the University of Pittsburgh Medical Center in Pennsylvania. “You can be surprised by a complication—or you can plan for it, troubleshoot in advance by playing out the scenario in your mind, and salvage the situation to help ensure the best possible outcome for your patient.”

Most unexpected developments fall into distinct categories of common complications, Dr. Sultan said. Experienced surgeons know to be prepared for the patient who may have trouble coming off bypass or the occasional patient with true intramyocardial coronary targets. 

“You can’t really tell a patient that, ‘Oh, by the way, I couldn’t find your coronary artery to bypass,’” said Dr. Sultan, who will co-moderate a session on Sunday morning that will provide tips on how to get out of tough situations in adult cardiac surgery. “It’s imperative that surgeons go into an operation knowing exactly how they will find true intramyocardial coronaries in the 2%–5% of patients where they do occur.”

Adult Cardiac Surgery SOS: How to Get Out of Tough Situations

10:00 a.m. – 12:00 p.m.
Room 217

Just as adult cardiac surgeons should plan for the possibility of an unexpected aortic dissection or a redo sternotomy using peripheral cannulation to establish cardiopulmonary bypass, congenital heart surgeons have their own challenges.

“Anticipation of and preparation for any potential scenario, whether in the operating room or anytime in perioperative period—no matter how unlikely—is critical to ensuring the best outcomes for our patients,” said Kristine J. Guleserian, MD, from Medical City Children’s Congenital Heart Surgery in Dallas.

Congenital Cardiac Surgery SOS: How to Get Out of Tough Situations

10:00 a.m. – 12:00 p.m.
Room 208

“Our SOS session on Sunday will highlight some of the situations congenital heart surgeons have experienced or certainly will experience at some time in their careers,” said Dr. Guleserian, who will co-moderate the session. “The goal is to have rehearsed a strategy and be ready.”

For example, there is always the potential for neoaortic regurgitation following a stage 1 Norwood palliation or problems weaning a patient from cardiopulmonary bypass after an arterial switch operation. A session on planning for obstacles encountered during congenital heart surgery also will be held on Sunday morning.

“These sessions will provide an environment where it is okay to talk about surgical challenges and how you did—or didn’t—get through them,” Dr. Sultan said. “We will all find ourselves in these circumstances during our careers, and these are the approaches, thought processes, and tips that can help you and your patients through tough situations.”