New guidelines on cardiovascular assessment and management in non-cardiac surgery were presented at the recent ESC Congress 2014 in Barcelona.
The new guidelines focus on patients in whom heart disease is a potential source of complications during surgery. They present an evidence-based, stepwise approach to determining which patient benefits from cardiac testing, coronary artery revascularisation, and cardiovascular therapy before surgery.
Currently, there is no systematic European data available on the annual number and type of operations, nor on patient outcome – but it is estimated that around 19 million major procedures are undertaken annually.
The majority of procedures are performed in patients with minimal cardiovascular risk. Thirty per cent of patients undergo extensive surgical procedures in the presence of cardiovascular co- morbidity. Therefore, 5.7 million procedures are performed each year in European patients who present with an increased risk of cardiovascular complications. At least 167,000 cardiac complications, of which 19,000 are life- threatening, as a result of 312 non-cardiac surgical procedures annually have been estimated.
The guidelines recommend an evaluation of the patient that integrates clinical risk factors and test results with the estimated stress of the planned procedure. This means an individualised cardiac risk assessment, with the opportunity to initiate medical therapy, coronary interventions, and specific surgical and anaesthetic techniques to optimise the patient’s perioperative condition. Emphasis is placed on the restricted use of prophylactic coronary revascularisation, as this is rarely indicated simply to ensure that the patient survives surgery.
The majority of patients with stable heart disease can undergo low and intermediate risk surgery without additional evaluation. Selected patients require an integrated multidisciplinary approach from anaesthesiologists, cardiologists, internists, pulmonologists, geriatricians, and surgeons.
