Operative Management of Nonischemic Cardiogenic Shock

The spectrum of presentations for cardiogenic shock resulting from nonischemic etiologies can range from extremis, where there is little time for preparation or thought before intervening surgically, to cardiogenic failure that can be temporized with measures such as inotropic support or assist devices, allowing more preparation and planning before surgery. These diverse etiologies range from traumatic to iatrogenic and include infectious, ischemic, and degenerative causes. (For a detailed discussion of ischemic valvular disease, see Chapter 11.) This chapter will review penetrating and blunt cardiac trauma, iatrogenic cardiac injuries, and obstructive and infectious valvular heart disease. Various operative techniques required by each entity will be reviewed.