{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:35:22Z","timestamp":1788863722789,"version":"build-2803163510"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:p>Challenging times are here for cardiac surgical and anesthesia team. The interventional cardiologist seem to have closed the flow of \u2018good cases\u2019 coming up for any of the surgery,; successful percutaneous interventions seem to be offering reasonable results in these patients, who therefore do not knock on the doors of the surgeons any more. It is a common experience among the cardiac anesthesiologists and surgeons that the type of the cases that come by now are high risk. That may be presence of comorbidities, ongoing medical therapies, unstable angina, uncontrolled heart failure and rhythm disturbances; and in patients with ischemic heart disease, the target coronaries are far from ideal. Several activities such as institution of preoperative supportive circulatory, ventilatory, and systemic disease control maneuvers seem to have helped improving the outcome of these \u2018high risk \u2018 patients. This review attempts to look at various interventions and the resulting improvement in outcomes. Several changes have happened in the realm of cardiac surgery and several more are en route. At times, for want of evidence, maximal optimization may not take place and the patient may encounter unfavorable outcomes. This review is an attempt to bring the focus of the members of the cardiac surgical team on the value of preoperative optimization of risks to improve the outcome. The cardiac surgical patients may broadly be divided into adults undergoing coronary artery bypass graft surgery, valve surgery and pediatric patients undergoing repair\/palliation of congenital heart ailments. Optimization of risks appear to be different in each genre of patients. This review also brings less often discussed issues such as anemia, nutritional issues and endocrine problems. The review is an attempt to data on ameliorating modifiable risk factors and altering non modifiable ones.<\/jats:p>","DOI":"10.4103\/aca.aca_20_17","type":"journal-article","created":{"date-parts":[[2017,4,6]],"date-time":"2017-04-06T11:15:08Z","timestamp":1491477308000},"page":"226-233","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":25,"title":["Modifying Risks to Improve Outcome in Cardiac Surgery: An Anesthesiologist's Perspective"],"prefix":"10.4103","volume":"20","author":[{"given":"Murali","family":"Chakravarthy","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250528","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/BF03007718","article-title":"A simple classification of the risk in cardiac surgery","volume":"30","author":"Paiement","year":"1983","journal-title":"Can Anaesth Soc J"},{"issue":"6 Pt 2","key":"R2-20250528","first-page":"I3","article-title":"A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease","volume":"79","author":"Parsonnet","year":"1989","journal-title":"Circulation"},{"key":"R3-20250528","doi-asserted-by":"crossref","first-page":"2110","DOI":"10.1161\/01.CIR.85.6.2110","article-title":"Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. 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