CHAPTER 34 Non-cardiac Surgery in Cardiac Patients
The number of cardiac patients undergoing non-cardiac surgery is steadily increasing. Some patients may be at substantial risk of perioperative morbidity and mortality. In this respect, vascular surgery is considered as high-risk surgery. Perioperative myocardial infarctions (PMIs) are the predominant cause of morbidity and mortality in patients undergoing non-cardiac surgery. The pathophysiology of PMI is complex. Prolonged myocardial ischaemia due to the stress of surgery, in the presence of a haemodynamically significant coronary lesion leading to subendocardial ischaemia, and acute coronary artery occlusion after plaque rupture and thrombus formation, contribute equally to these devastating events. Preoperative management aims at optimizing the patient’s condition by identification and modification of underlying cardiac risk factors and diseases. Beta-blockers and statins are widely used in this setting. In contrast, the role of prophylactic coronary revascularization has been restricted to the same indications as the non-operative setting. This chapter will review the main aspects of perioperative care and management of cardiac patients undergoing non-cardiac surgery in line with the recent European Society of Cardiology guidelines on perioperative care.
Chapter 28)
