Ischemic heart disease is the leading course of death worldwide. However, recent advances in coronary revascularization methods have improved the outcome substantially (ACCF & AHA, 2011). Cardiac surgery, along with endovascular techniques, reduces mortality and morbidity. Accurate management of coronary artery disease makes it possible to make patients’ lives longer, more active and less painful. Cardiac surgery due to its advanced techniques like coronary artery bypass grafting (CABG) is a major advance of clinical medicine in the twenty-first century. Thus, appropriate perioperative patterns are essential to manage diseased with coronary artery lesions.
Data flow diagrams illustrate information flow as it transforms from the incoming data to the outgoing files. In cardiac surgery, many factors concerning patients must be taken into account, since all of them make a strong impact on the overall outcome. For example, should a patient have concomitant diseases of other organs, surgery might be contraindicated. Therefore, this kind of input data changes the outcome. Moreover, even if surgery has been performed perfectly, adequate postoperative care must be conducted. Otherwise, the condition would deteriorate and the whole approach may fail to show its positive impact. The postoperative support is based on logical approach and flexible decisions. The accuracy of these patterns may be tracked by using data flow diagrams (ICSI, 2010).
As soon as the patient is admitted at the cardiac surgical department, a thorough clinical investigation must be conducted. The most important question concerning cardiac status is the anatomy of the coronary lesions. Normally, in a human there are three coronary arteries. Cardiac surgery is best indicated when two or more coronary arteries are affected by atherosclerosis. Should only one artery be diseased, endovascular treatment may be considered. Preoperative evaluation derives other diseases, like renal failure or diabetes. According to the current recommendation of the American Heart Association (2011), co-morbidity also shifts the decision towards surgery rather than coronary stenting. Adequate consideration and appropriate patient selection are of paramount importance for successful outcome. It should be noted here, that according to the periperative protocol of the Institute for Clinical Systems Improvement, (2010) “If any part of the verification process was not followed and/or a discrepancy is discovered, the procedure is halted and will not continue until the missing steps of the verification process are completed and the discrepancies resolved”.
When the patient is in the procedure area, all members of the surgical team are expected to be in the operating room. As soon as all environmental controls for surgical sepsis verified, anesthesia is administrated. As for cardiac surgery, a very specific pattern should be minded: if the patient has severe atherosclerotic lesions, cardiopulmonary bypass is most probably to be used. However, when the lesions are not multiple and anatomically easy to access, coronary bypass may be performed on beating heart. The latter is cheaper and carries less postoperative risks (ESC & EACTS, 2010). When the operation is over, the cardiac team closes the wound, and the patient is transported into the intensive care unit.
Post-anesthesia care is typically under control of the surgeon or the anesthesiologist. The critical issue that the attending physician must recognize is the cardiac status. In case the heart fails to perform satisfactory, inotropic support must be administrated, followed by mechanical support device. The condition is expected to improve within days and the patient is extubated to recover. The next step that is inevitable for the perioperative protocol is wound care, antibiotic discontinuation, and patient education before the discharge. Patient education is mandatory for long-term benefits because these patients usually require drug support life-long (ESC & EACTS, 2010).
The process of health care delivery carries extreme responsibility. A properly designed data flow protocol is expected to control the process of decision taking adequately and objectively. The structured design of cardiac surgery perioperative protocol is aimed to assist in understanding what, why and how happens to the cardiac patient. A properly conducted model carries numerous advantages to the patient.