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Non-cardiac surgery in patients with valvular heart disease.

Authors
  • Sorrentino, Regina1, 2
  • Santoro, Ciro1
  • Bardi, Luca1
  • Rigolin, Vera3
  • Gentile, Federico4
  • 1 Department of Advanced Biomedical Science, Federico II University Hospital, Napoli, Italy. , (Italy)
  • 2 Centro Cardiologico Gentile, Napoli, Campania, Italy. , (Italy)
  • 3 Medicine/Cardiology, Northwestern University, Chicago, Illinois, USA.
  • 4 Centro Cardiologico Gentile, Napoli, Campania, Italy [email protected] , (Italy)
Type
Published Article
Journal
Heart
Publisher
BMJ
Publication Date
Jul 13, 2022
Volume
108
Issue
15
Pages
1171–1178
Identifiers
DOI: 10.1136/heartjnl-2021-319160
PMID: 34815334
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In patients with significant valvular heart disease (VHD) undergoing non-cardiac surgery (NCS), perioperative adverse cardiac events are a relevant issue. Although postoperative outcomes can be adversely affected by valve-related haemodynamic instability, recommended perioperative risk scores prioritise the risk of the surgical procedure and the presence of cardiovascular risk factors, neglecting the presence or extent of VHD. Perioperative management and anaesthetic approach should focus on the underlying type and severity of VHD, the compensatory mechanisms deployed by left ventricle and right ventricle and the type and risk of NCS. Due to the lack of randomised trials investigating different therapeutic approaches of valvular intervention prior to NCS, recommendations mainly rely on consensus opinion and inference based on large observational registries. As a general rule, valvular intervention is recommended prior to NCS in symptomatic patients or in those who meet standard criteria for cardiac intervention. In the absence of such conditions, it is reasonable to perform NCS with tailored anaesthetic management and close invasive perioperative haemodynamic monitoring. However, patient-specific management strategies should be discussed with the heart team preoperatively. Symptomatic patients with severe VHD or those undergoing high-risk NCS should ideally be treated at a high-volume medical centre that is equipped to manage haemodynamically complex patients during the perioperative period. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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