Preoperative Assessment of the Patient with Cardiac Disease

The past several years has seen a dramatic increase in the number and quality of randomized and prospective studies to define the optimal and most cost-effective approach to preoperative cardiovascular evaluation and management for noncardiac surgery, including studies evaluating the role of coronary revascularization before noncardiac surgery and perioperative beta-blockers. In 2009, the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines on Perioperative Cardiovascular Evaluation before Noncardiac Surgery were updated which included a new algorithm (2007) and new recommendations regarding perioperative beta-blockade usage.[1] In addition, the European Society of Cardiology (ESC) has also produced Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery, which has been endorsed by the European Society of Anaesthesiology (ESA).[2] These recommendations are similar to the AHA/ACC recommendations with an algorithm, although the beta-blocker recommendations are slightly different. 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. In the case of cardiovascular disease, the preoperative evaluation attempts to define the extent of coronary artery disease and the left ventricular function.