Internal and Emergency Medicine

, Volume 13, Issue 8, pp 1185–1190 | Cite as

Perioperative care of cardiac patient’s candidate for non-cardiac surgery: a critical appraisal of emergent evidence and international guidelines

  • Felice Gragnano
  • Davide CattanoEmail author
  • Paolo Calabrò


The perioperative management of a cardiac-patient candidate to non-cardiac surgery (NCS) remains a topic of considerable debate. In recent years, the overall tendency from professional societies has been to delineate how to identify and manage high-risk patients following the best evidence. However, significant concerns persist, especially in the care of intermediate-risk patients (also labeled at “acceptable” risk), who may not fit into the categories of “completely healthy” or “critically ill”, but that might still encounter dramatic (and unexpected) perioperative events. The specific interest and main goal of this expert viewpoint pertains to the care of cardiac patients scheduled for NCS, addressing central questions of real-life clinical care that practicing anesthesiologists and cardiologists face daily, discussing recent American College of Cardiology/American Heart Association (ACC/AHA), European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA), and Canadian Cardiovascular Society (CCS) guidelines. The viewpoint aims to discuss few of the important topics pertaining perioperative assessment and management: type of NCS and perioperative cardiac events, risk prediction including testing, and perioperative management of cardiac therapy. The fact that cardiac adverse events have reduced in number mostly due to better preoperative management and prevention should not prompt a reduction in clinical evaluations. While debate remains pertaining the most appropriate way to evaluate patients for NCS within international societies, a comprehensive approach-evaluation best recognized to assess functional and heart status, should be maintained, keeping into consideration the surgical procedure and global health management.


Perioperative management Preoperative optimization Cardiac patient for non-cardiac surgery Pre-anesthesia evaluation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent is not required.


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Copyright information

© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  1. 1.Division of Clinical CardiologyA.O.R.N. Sant’Anna e San SebastianoCasertaItaly
  2. 2.Department of Translational Medical SciencesUniversity of Campania “Luigi Vanvitelli”NaplesItaly
  3. 3.McGovern Medical SchoolUTHealth at HoustonHoustonUSA

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