**9. Abbreviations**

298 Perioperative Considerations in Cardiac Surgery

46±20 mmHg (after CPB) (p<0.001). In contrast, SPAP remained unchanged in the control group (*n*=11) and no significant differences between groups were observed in decreased

A retrospective study reporting the preliminary experience on the use of inhaled milrinone at the Montreal Heart Institute was conducted in 70 high risk patients with a mean Parsonnet Score of 27±14 (Bernstein & Parsonnet, 2000; Lamarche et al., 2007). Results were compared to those of a control group with similar baseline characteristics. In conclusion, the administration of inhaled milrinone prior to CPB (*n*=30) was associated with a lower chance of CPB re-initiation (9 *vs* 1; p=0.021) and lower postoperative PAP. Further studies (#

In addition to therapeutic approaches to the prevention of PH, the choice of type and size of aortic prosthetic valve may be a very important factor. As previously discussed, it has been shown that, if the EOA of the aortic valve is too small relative to body size, the so-called PPM, the intraoperative and long-term mortality will increase (Milano et al., 2001; Rao et al., 2000; Pibarot & Dumesnil, 2000; Blais et al., 2003; Ruel et al., 2004; Pibarot & Dumesnil, 2006; Tasca et al., 2006; Kulik et al., 2006). Hence, prevention of PPM may contribute to reducing PH after cardiac surgery and facilitate separation from CPB. This includes strategies such as the implantation of a prosthesis with better performance (stentless bioprosthesis, new generation bileaflet mechanical valve, new generation supra-annular stented bioprosthetic valve) or enlargement of the aortic root (Fig. **9**) in order to accommodate a larger prosthesis. On the other hand, some strategies used to prevent PPM are complex and may even increase the risk of difficult weaning from CPB extending the duration of the surgical procedure and consequently, CPB duration. Unfortunately, in some cases, the drawbacks of using alternative procedures may supercede the benefits of avoiding PPM. Therefore, the establishment of accurate criteria for a better assessment of the benefit-risk ratio with respect to the prevention of PPM is essential. In the case of mitral valve PPM, the best option would be to favor mitral valve repair rather than replacement. However, mitral valve repair may not be possible in a significant number of patients, which limits the options when compared

Pulmonary hypertension and its most dreaded consequence, RV dysfunction, are important mortality risk factors in cardiac surgery. Accordingly, all cardiac patients may benefit from early diagnosis and/or treatment prior to the surgical procedure. In patients with PH, further evaluation of potential alterations in the RV function would be relevant. Thus, future trials should prioritize in-depth exploration of preventive approaches in order to address the role of preemptive reduction of PH severity before cardiac surgery and to determine its

The authors sincerely thank Antoinette Paolitto and Denis Babin for their help with the chapter submission and Sybil Skinner Robertson and Paul Gavra for their help with the

NCT00819377) are underway to determine the efficacy of this approach.

systemic arterial pressures.

**6.2 Non-pharmacological** 

to aortic valve replacement (Magne et al., 2007).

impact on postoperative outcomes and survival improvement.

**7. Conclusion** 

**8. Acknowledgements** 

chapter review.



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