[Preoperative cardiovascular assessment in non-cardiac surgery: the role of non-invasive procedures].
The aim of cardiovascular preoperative evaluation in non-cardiac surgery is to assess the patient's current cardiovascular status, to detect unknown diseases, to make recommendations concerning the medical management of the patient in the peri- and postoperative period, to plan the surgical strategy or, in some cases, to postpone non-cardiac surgery until the cardiac condition is corrected or stabilized; rarely, cardiovascular evaluation may result in an absolute contraindication for non-cardiac surgery. The basic clinical evaluation obtained by history, physical examination and review of the ECG usually provides enough data to estimate the cardiac risk. Patient's risk factors (unstable coronary syndromes, congestive heart failure, life-threatening arrhythmias, severe valvular heart diseases) and the type and setting of surgery are to be considered together with the clinical evaluation. Additional non-invasive tests may be recommended to evaluate left ventricular function and the presence of myocardial ischemia only if expected data will eventually result in changing the surgical procedure or perioperative management. Echocardiography is particularly useful in patients with major risk factors whereas exercise stress test is able to assess the patient's functional capacity or to identify silent myocardial ischemia or significant arrhythmias. The overall goal of cardiac assessment should be a consideration of both the impending surgery and the long-term cardiac risk independent of the decision to go to surgery. It is almost never appropriate to recommend coronary bypass surgery or other invasive interventions such as coronary angioplasty in an attempt to reduce the risk of non-cardiac surgery when they would not otherwise be indicated.
Mori
Fabio
F
U.O. di Cardiologia 3, Azienda Ospedaliera Careggi, Viale Pieraccini, 17 50139 Firenze.
Zuppiroli
Alfredo
A
D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002320:Cardiovascular Physiological Phenomena; D004452:Echocardiography / Q000379:methods; D005080:Exercise Test; D006801:Humans; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors
Valutazione cardiovascolare preoperatoria nella chirurgia non cardiaca: il ruolo delle indagini strumentali non invasive.