ABDELMAKSOUD ELGANADY

Erfan and Bagedo Hospital, Saudi Arabia

Title: Cardiovascular Assessment and management of patient undergoing non-cardiac Surgery- 2022

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Biography

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Abstract

Background and why is there a need for such a guideline?

·  The annual volume of major surgery worldwide is estimated to be >300 million patients (about 5% of the world population).

·  Nearly half of adults aged ?45 years undergoing major non-cardiac surgery (NCS) present with:

o At least two cardiovascular risk factors

o 18% have coronary artery disease

o 4.7% have a history of stroke

o 7.7% had a modified Revised Cardiac Risk Index (RCRI) score ?3

·  The rates of NCS after PCI were 11% and 24%, 1 and 3 years after PCI respectively.

·  The cut-off ages at which NCS was more likely to occur within 1 and 3 years of PCI were 62 and 73 years respectively

Importantly our population is rapidly ageing. As a result, the number of patients in need of non-cardiac surgery (NCS) continues to increase.

·  Up to 8% of these patients require critical care admission with a mean in-hospital mortality of 4% resulting in >4 million post-operative deaths every year.

·  The risk of cardiovascular morbidity and mortality in patients undergoing NCS is the result of an interplay between patients-related risk and the intrinsic risk of surgery dependent on the circumstances under which it takes place (immediate, urgent, time-sensitive and elective) and its type (low, intermediate, and high risk).

 

This is a summary of new recommendations and expanded topics within the 2022 European Society of Cardiology (ESC) guidelines on cardiovacular (CV) assessment and management of patients undergoing non-cardiac surgery (NCS). The following are key points to remember:

Perioperative CV complications dramatically impact overall postoperative prognosis of patients undergoing NCS. Risk is influenced by a) presence and optimization of patient-specific comorbidities, b) complexity of the planned surgical procedure, and c) the clinical urgency of surgery

1Patient-specific risk factors should be identified and optimized during preoperative evaluation as time permits.

2Stratification of surgical risk as low, intermediate, or high along with patient-specific CV risk factors collectively inform the approach to CV testing.

3. When high-risk surgery is planned in patients with high CV risk, less invasive surgical techniques should be considered.