Cardiac Patients and Noncardiac Surgery: Pathophysiological Basis for Clinical Management
Improvement in heart failure therapy and perioperative management (technology and hemodynamic monitoring system) has led to an increasing number of cardiac patients eligible for anesthesia and surgery.
Patients who underwent previous surgical correction of VHD (valvular heart disease) and have a prosthetic (biological or mechanical) valve can undergo noncardiac surgery without additional risk, provided that there is no evidence of valve or ventricular dysfunction (tested with echocardiographic evaluation). They clearly need a modification of anticoagulant regimen in the perioperative period. Antibiotic prophylaxis is recommended in all patients at intermediate or high risk of infective endocarditis in the field of noncardiac surgery.
Patients with coronary stents need an accurate evaluation and management of antiplatelet therapy to avoid stent thrombosis.
In this chapter we will discuss the physiopathology of the most frequent heart diseases, excluding the rarer or congenital ones.
KeywordsIschemic heart disease Valve heart disease Transesophageal echocardiography Cardiac anesthesia Anesthesia in noncardiac surgery
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