In general, preoperative myocardial revascularization (e.g., PCI, CABG) is indicated in patients for whom it would be indicated even if there were no elective surgery, e.g., selected patients with very symptomatic CAD despite medical therapy, or those with strongly positive ECG exercise or pharmacological radionuclide or echo stress tests. Otherwise, no data exists to support doing prophylactic PCI or CABG before noncardiac surgery just to reduce the incidence of postoperative cardiac complication. Coronary stents are now being used in more than 80% of percutaneous coronary interventions. It is prudent to delay elective surgery for at least four weeks after intracoronary stenting, to allow complete endothelialization and to avoid the possibility of acute stent thrombosis that may result from discontinuation of anticoagulant therapy (i.e., aspirin, clopidogrel) prior to planned surgery.

Clinical experience indicates that patients with symptomatic valvular AS severe enough to warrant surgical treatment should have valve surgery (or catheter balloon valvuloplastry as a temporizing step) before elective ( or urgent) noncardiac surgery. Patients with severe MR may benefit from afterload reduction and diuretic therapy to produce maximal hemodynamic stabilization before high risk surgery. The severity of valvular lesions should be determined prior to surgical to allow for appropriate fluid management and consideration of invasive intraoperative monitoring.All patients with valvular heart disrase should receive appropriate antibiotic prophylaxis for endocarditis.

Myocardial ischemia and adverse postoperative cardiac events may occur with a postoperative hypercoagulable state, surge in catecholamine levels, hemodynamic changes, hypoxemia, and fluid shifts. For high risk patients, administering beta blockers preoperatively and maintaining treatment uninterrupted as long as possible(especially in patients with CAD) may be helpful in reducing these complications (particularly ischemia and postoperative MI and arrhythmias). Most cardiac medications should be continued up to surgery, especially antianginal and antihypertensive medications. The practitioner should excercise particular caution in withdrawing beta blockers and clonidine because of potential rebound ischemia and/or hypertension. Because of other pain or sedation, perioperative MIs may be "silent" or present with other signs (e.g., CHF or arrhythmias).

Your Comments

Click here to add a comment

Name:


Location:


Email:


Comment:




Please enter the Captcha code:

There are no comments to display