The demographics of cardiac surgical patients are changing. The average age at operation has risen 10 years since 1980, and the risk of surgery related to severe atherosclerosis of the aorta and its branches is increasing. Although cardiac risk is increasing, operative techniques to minimize cardiac risk have placed the emphasis on comorbid conditions. Patients with preexisting unstable cerebral, vascular, renal, and hepatic disease are at a markedly increased risk and should be carefully evaluated preoperatively.
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