Cardiac Issues With Noncardiac SurgeryPresentation Transcript
Cardiac Issues With Noncardiac Surgery Joseph F. Winget, MD FACC Clinical Assistant Professor University of Vermont Medical School Champlain Valley Cardiovascular Associates, P.C.
Preoperative risk assessment
Anticoagulation and antithrombotic issues
Surgery or not?
87 year old white female with known critical AS fall and breaks her hip.
No CHF, MI, syncope
Stable and relatively independent before the fall.
82 year old white male with known CAD. Stable angina pectoris.
Catheterization shows occluded LAD which was fed by collaterals
AODM and HTN
Severe worsening spinal stenosis and weakness
Preoperative cardiac issues
How healthy is the patient?
How active is the patient?
How risky in the planned surgery?
Is preoperative cardiac testing necessary?
What preventive measures can be taken to reduce cardiac risk?
L’Italien JACC 1996;27:779
JACC 2002; 39:542
JACC 2002 39:542
Is testing predictive of outcomes? Circ 1997; 95: 53
Cardiac event rates and dobutamine echocardiography JAMA 2001; 285:1865
Who to test?
Intermediate risk patients undergoing intermediate or high risk surgery
Testing does not add additional information in low risk or high risk patient groups.
Exercise or pharmacologic echocardiography
Exercise or pharmacologic Cardiolite
Not well validated
Therapies to reduce perioperative cardiac complications
Benefit of CABG Circ 1997; 96: 1882
McFalls E et al. N Engl J Med 2004;351:2795-2804 Long-Term Survival among Patients Assigned to Undergo Coronary-Artery Revascularization or No Coronary-Artery Revascularization before Elective Major Vascular Surgery
McFalls E et al. N Engl J Med 2004;351:2795-2804 Long-Term Use of Medical Therapy in the Revascularization and No-Revascularization Groups at 24 Months after Randomization
Medical therapy to lower risk Lindenauer, PK JAMA. 2004 May 5; 291(17)2092
Beta blocker use? NEJM 1996; 335:1713
Beta blocker use?
Revascularization for appropriate clinical indications