Heart Failure

  • Michael J. LenaeusEmail author
  • Kelly M. Nakamura


Heart failure (HF) is one of the most prevalent diseases in the world and commonly confounds surgery of all types. Preoperative identification of previously undiagnosed HF or decompensated HF can allow for stabilization prior to surgery or highlight the need for cardiology referral if HF is severe, the patient remains refractory to therapy, or surgery is urgent. Perioperative management should be performed with standard medical therapy of HF, with close attention paid to the volume of fluid infused during surgery and the patient’s postoperative volume status.


Congestive heart failure CHF Heart failure HF Preoperative Perioperative 


  1. 1.
    Mozaffarian D, et al. Heart disease and stroke statistics – 2015 update. Circulation. 2015;131:e29–e322.Google Scholar
  2. 2.
    Hammill BG, et al. Impact of heart failure on patients undergoing major noncardiac surgery. Anesthesiology. 2008;108:559–67.CrossRefGoogle Scholar
  3. 3.
    Hernandez AF, et al. Outcomes in heart failure patients after major noncardiac surgery. J Am Coll Cardiol. 2004;44:1446–53. Open image in new windowCrossRefGoogle Scholar
  4. 4.
    Van Diepen S, Bakal JA, McAlister FA, Ezekowitz JA. Mortality and readmission of patients with heart failure, atrial fibrillation, or coronary artery disease undergoing noncardiac surgery: an analysis of 38 047 patients. Circulation. 2011;124(3):289–96. Open image in new windowCrossRefGoogle Scholar
  5. 5.
    Lee TH, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043.CrossRefGoogle Scholar
  6. 6.
    Bertges DJ, et al. The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the revised cardiac risk index in vascular surgery patients. J Vasc Surg. 2010;52:674.CrossRefGoogle Scholar
  7. 7.
    Bilimoria KY, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217:833.CrossRefGoogle Scholar
  8. 8.
    Healy KO, et al. Perioperative outcome and long term mortality for heart failure patients undergoing intermediate and high risk non-cardiac surgery: impact of left ventricular ejection fraction. Congest Heart Fail. 2010;16(2):45–9.CrossRefGoogle Scholar
  9. 9.
    Kazmers A, Cerqueira MD, Zierler RE. Perioperative and late outcome in patients with left ventricular ejection fraction of 35% or less who require major vascular surgery. J Vasc Surg. 1988;8(3):307–15.CrossRefGoogle Scholar
  10. 10.
    Doughty RN. The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis: Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). Eur Heart J. 2012;33:1750–7.CrossRefGoogle Scholar
  11. 11.
    Flu W-J, et al. Prognostic implications of asymptomatic left ventricular dysfunction in patients undergoing vascular surgery. Anesthesiology. 2010;112:1316.CrossRefGoogle Scholar
  12. 12.
    Xu-Cai YO, et al. Elective noncardiac surgery in stable heart failure. Outcomes of patients with stable heart failure undergoing elective noncardiac surgery. Mayo Clin Proc. 2008;83:280–8.CrossRefGoogle Scholar
  13. 13.
    McGee S. Evidence-based physical diagnosis: 4th edition, Elsevier Inc; Philadelphia, PA, 2018.CrossRefGoogle Scholar
  14. 14.
    Fleisher LA, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;64:2373.CrossRefGoogle Scholar
  15. 15.
    Yancy CW, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240–327.PubMedGoogle Scholar
  16. 16.
    Roshanov PS, et al. Enzyme inhibitors or angiotensin II receptor blockers. Anesthesiology. 2017;126:16–27.CrossRefGoogle Scholar
  17. 17.
    Zou Z, et al. Perioperative angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers for preventing mortality and morbidity in adults. Cochrane Database Syst Rev. 2016;(1):CD009210.Google Scholar
  18. 18.
    Rouleau JL, et al. Effects of angiotensin-converting enzyme inhibition in low-risk patients early after coronary artery bypass surgery. Circulation. 2008;117:24–31.CrossRefGoogle Scholar
  19. 19.
    Turan A, et al. Angiotensin converting enzyme inhibitors are not associated with respiratory complications or mortality after noncardiac surgery. Anesth Analg. 2012;114:552–60.CrossRefGoogle Scholar
  20. 20.
    Devereaux PJ, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371(9627):1839–47.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Medicine, Division of General Internal MedicineUniversity of WashingtonSeattleUSA

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