Cardiothoracic surgeons are requested to operate during various life-threatening conditions like massive saddle Pulmonary embolism (PE), Aortic Dissections (TAAD), emergency CABG surgeries and other iatrogenic traumas.
• Saddle PE is a life-threatening condition where right heart fails to push blood into the pulmonary circulation because of large clot burden in the pulmonary arteries (figure 1) and patient become hypoxic and deteriorate quickly if not promptly managed. Decision to operate these cases is a team venture and common consensus prevails and the surgical removal of PE is performed.
• Aortic dissection is another serious condition where rate of death in un-treated patients is extremely high and require urgent dissection repair. These procedures are high risk with relative high mortality and morbidities, but surgery is the only option for the good mid to long-term outcomes (figure 2).
• Infection leading to severe haemodynamic compromise: Infective Endocarditis is another life-threatening condition and might require surgical debridement and correction (figure 3).
• Emergency coronary surgery: incidences of emergency CABG are constantly going down with improving stenting techniques, but surgeons are still requested to bail-out in these unstable high-risk cases. I prefer OPACBG or beating heart for these cases unless patient is severely compromised.
• Intervention catheter induced perforation and cardiac tamponade (fluid around the heart chambers) are another subgroup of the cases require urgent surgical attention.