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Essential Cardiology pp 727–736Cite as

Assessment of Patients with Heart Disease for Fitness for Noncardiac Surgery

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Abstract

The basic tenet in preoperative evaluation remains that information regarding the extent and stability of disease will effect patient management and lead to improved outcome. The history should focus on cardiovascular risk factors and symptoms or signs of unstable cardiac disease states. Six independent predictors of complications have been identified: high-risk type of surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, preoperative treatment with insulin, and preoperative serum creatinine >2.0 mg/day, with increasing cardiac complication rates noted with increasing number of risk factors. In 2009, the American College of Cardiology/American Heart Association produced guidelines which include an algorithm to determine the indication for further diagnostic evaluation which incorporates clinical risk, surgical procedure risk, and exercise capacity. Current evidence suggests that further risk stratification in this group of patients considered at intermediate risk based on clinical history alone was unnecessary as long as perioperative beta-blockers were used, while those patients with left main disease may benefit from testing. The current evidence does not support the use of percutaneous coronary interventions beyond established indications for nonoperative patients, while advocates continuing aspirin therapy in all patients with a coronary stent and discontinuing clopidogrel for as short a time interval as possible. With respect to perioperative medical therapy, current evidence supports the continuation of beta-blockers and statins.

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Recommended Reading

  • Devereaux PJ, Yang H, 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.

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  • Fleisher LA, Beckman JA, et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol. 2009;54(22):e13–118.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Suite 680 Dulles, Philadelphia, PA, 19104, USA

    Lee A. Fleisher MD & Joseph S. Savino MD

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  1. Lee A. Fleisher MD
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  2. Joseph S. Savino MD
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Correspondence to Lee A. Fleisher MD .

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Editors and Affiliations

  1. The Mount Sinai School of Medicine, The James J. Peters VA Medical Center, Department of Medicine, West Kingsbridge Rd 130, Bronx, 10468, New York, USA

    Clive Rosendorff

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Fleisher, L.A., Savino, J.S. (2013). Assessment of Patients with Heart Disease for Fitness for Noncardiac Surgery. In: Rosendorff, C. (eds) Essential Cardiology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6705-2_43

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  • DOI: https://doi.org/10.1007/978-1-4614-6705-2_43

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