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The Patient with Advanced Chronic Heart Failure

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Anesthesia in High-Risk Patients

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Abstract

Heart failure (HF) is a growing healthcare problem and has emerged as a particular challenge in the field of perioperative medicine. It is since long a well-known risk factor for postoperative cardiac events, associated with high mortality rates even after minor surgery. Compared to ischemic heart disease, however, HF has received relatively little scientific attention within our specialty, and perioperative outcome has not changed much over the years.

Congestive heart failure is primarily a disease of the elderly. As the population is aging, the prevalence is rising quickly. HF is an end-stage syndrome that can evolve from a variety of primary cardiac diseases and covers a heterogeneous clinical spectrum. An important distinction is made between two equally represented phenotypes that differ with regard to measured ejection fraction. HF with reduced ejection fraction (HFrEF) is characterized primarily by a limitation in systolic pump performance, while the most obvious feature of HF with preserved ejection fraction (HFpEF) is diastolic dysfunction.

The current therapeutic approach to HFrEF consists of staged neurohormonal modulation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic reflexes, based on strong scientific evidence for improved outcome. For HFpEF, in contrast, there is as yet no effective treatment with a similar impact on survival.

The cited prevalence of HF in patients presenting for noncardiac surgery varies between 2, 5% and 10% and is expected to increase as well. Recent guidelines emphasize the importance of risk assessment and risk modification strategies, but there is remarkably little scientific data to guide clinical decision making in the perioperative setting. The current best option is to develop a perioperative management plan in a multidisciplinary setting, based on a fair understanding of the syndrome’s pathophysiology, its treatment modalities and their impact, a thorough knowledge of advanced hemodynamic support and available monitoring techniques, with provision of extended postoperative follow-up in a high care facility.

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Authors and Affiliations

  1. Department of Anaesthesia and Perioperative Medicine, Ghent University and University Hospital, Ghent, Belgium

    Patrick F. Wouters & Koen Lapage

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  1. Patrick F. Wouters
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Correspondence to Patrick F. Wouters .

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Editors and Affiliations

  1. Department of Anaesthesiology and Critical Care Medicine, Louis Pradel Hosp, Hospices Civils Lyon, Lyon, Rhône, France

    Jean-Luc Fellahi

  2. Service d'Anesthésie-Réanimation, Hôpital Nord, Marseille cedex 20, France

    Marc Leone

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Wouters, P.F., Lapage, K. (2018). The Patient with Advanced Chronic Heart Failure. In: Fellahi, JL., Leone, M. (eds) Anesthesia in High-Risk Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-60804-4_2

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  • DOI: https://doi.org/10.1007/978-3-319-60804-4_2

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