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Perioperative Evaluation and Management of Patients Undergoing Noncardiac Surgery

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Practical Cardiology

Abstract

Over 36 million patients undergo surgical procedures in the United States annually [1]. Around one-third of the patients undergoing surgeries have risk factors for or known cardiovascular disease [2]. The risk of perioperative cardiac complications is related to underlying cardiovascular disease burden [3]. Given the prevalence of cardiovascular disease, it is imperative for a practicing physician to perform an individualized evaluation of the surgical patient to provide an accurate preoperative risk assessment, risk stratification, and allow for modification of management strategies. This chapter outlines a systematic algorithm approach for cardiovascular risk assessment to guide perioperative strategies that may improve outcomes.

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References

  1. Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016;94(3):201–9F. https://doi.org/10.2471/blt.15.159293. Epub 2016/03/12. PubMed PMID: 26966331; PubMed Central PMCID: PMCPMC4773932.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mangano DT, Goldman L. Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med. 1995;333(26):1750–6. https://doi.org/10.1056/nejm199512283332607. Epub 1995/12/28. PubMed PMID: 7491140.

    Article  CAS  PubMed  Google Scholar 

  3. Landesberg G, Shatz V, Akopnik I, Wolf YG, Mayer M, Berlatzky Y, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol. 2003;42(9):1547–54. PubMed PMID: 14607436.

    CAS  PubMed  Google Scholar 

  4. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;64(22):e77–137. https://doi.org/10.1016/j.jacc.2014.07.944. Epub 2014/08/06. PubMed PMID: 25091544.

    Article  PubMed  Google Scholar 

  5. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–9. Epub 1999/09/08. PubMed PMID: 10477528.

    CAS  PubMed  Google Scholar 

  6. Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124(4):381–7. https://doi.org/10.1161/circulationaha.110.015701. Epub 2011/07/07. PubMed PMID: 21730309.

    Article  PubMed  Google Scholar 

  7. Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surgeons. 2013;217(5):833–42 e1–3. https://doi.org/10.1016/j.jamcollsurg.2013.07.385. Epub 2013/09/24. PubMed PMID: 24055383; PubMed Central PMCID: PMCPMC3805776.

    Article  Google Scholar 

  8. Schouten O, Bax JJ, Poldermans D. Assessment of cardiac risk before non-cardiac general surgery. Heart. 2006;92(12):1866–72. PubMed PMID: 17105895.

    PubMed  PubMed Central  Google Scholar 

  9. Hyder JA, Reznor G, Wakeam E, Nguyen LL, Lipsitz SR, Havens JM. Risk prediction accuracy differs for emergency versus elective cases in the ACS-NSQIP. Ann Surg. 2016;264(6):959–65. https://doi.org/10.1097/sla.0000000000001558. Epub 2016/01/05. PubMed PMID: 26727094.

    Article  PubMed  Google Scholar 

  10. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(23):e663–828. https://doi.org/10.1161/CIR.0b013e31828478ac. Epub 2013/05/01. PubMed PMID: 23630129.

    Article  PubMed  Google Scholar 

  11. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv. 2013;82(1):E1–27. https://doi.org/10.1002/ccd.24776. Epub 2013/01/10. PubMed PMID: 23299937.

    Article  PubMed  Google Scholar 

  12. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol. 2002;39(3):542–53. PubMed PMID: 11823097.

    PubMed  Google Scholar 

  13. Mahar LJ, Steen PA, Tinker JH, Vlietstra RE, Smith HC, Pluth JR. Perioperative myocardial infarction in patients with coronary artery disease with and without aorta—coronary artery bypass grafts. J Thorac Cardiovasc Surg. 1978;76(4):533–7. PubMed PMID: 309029.

    CAS  PubMed  Google Scholar 

  14. Hertzer NR, Beven EG, Young JR, O’Hara PJ, Ruschhaupt WF 3rd, Graor RA, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984;199(2):223–33. PubMed PMID: 6696538.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Hertzer NR, Young JR, Beven EG, O’Hara PJ, Graor RA, Ruschhaupt WF, et al. Late results of coronary bypass in patients with peripheral vascular disease. II. Five-year survival according to sex, hypertension, and diabetes. Cleve Clin J Med. 1987;54(1):15–23. PubMed PMID: 3494549.

    CAS  PubMed  Google Scholar 

  16. Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297(16):845–50. https://doi.org/10.1056/nejm197710202971601. Epub 1977/10/20. PubMed PMID: 904659.

    Article  CAS  PubMed  Google Scholar 

  17. Cooperman M, Pflug B, Martin EW Jr, Evans WE. Cardiovascular risk factors in patients with peripheral vascular disease. Surgery. 1978;84(4):505–9. PubMed PMID: 694738.

    CAS  PubMed  Google Scholar 

  18. Hlatky MA, Boineau RE, Higginbotham MB, Lee KL, Mark DB, Califf RM, et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989;64(10):651–4. Epub 1989/09/15. PubMed PMID: 2782256.

    CAS  PubMed  Google Scholar 

  19. Goldman L, Hashimoto B, Cook EF, Loscalzo A. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation. 1981;64(6):1227–34. Epub 1981/12/01. PubMed PMID: 7296795.

    CAS  PubMed  Google Scholar 

  20. Weiner DA, Ryan TJ, McCabe CH, Chaitman BR, Sheffield LT, Ferguson JC, et al. Prognostic importance of a clinical profile and exercise test in medically treated patients with coronary artery disease. J Am Coll Cardiol. 1984;3(3):772–9. PubMed PMID: 6229569.

    CAS  PubMed  Google Scholar 

  21. Weiner DA, Ryan TJ, Parsons L, Fisher LD, Chaitman BR, Sheffield LT, et al. Long-term prognostic value of exercise testing in men and women from the Coronary Artery Surgery Study (CASS) registry. Am J Cardiol. 1995;75(14):865–70. PubMed PMID: 7732991.

    CAS  PubMed  Google Scholar 

  22. Froehlich JB, Eagle KA. Anaesthesia and the cardiac patient: the patient versus the procedure. Heart. 2002;87(1):91–6. PubMed PMID: 11751677.

    PubMed  PubMed Central  Google Scholar 

  23. Fletcher GF, Balady G, Froelicher VF, Hartley LH, Haskell WL, Pollock ML. Exercise standards. A statement for healthcare professionals from the American Heart Association. Writing Group. Circulation. 1995;91(2):580–615. PubMed PMID: 7805272.

    CAS  PubMed  Google Scholar 

  24. Reilly DF, McNeely MJ, Doerner D, Greenberg DL, Staiger TO, Geist MJ, et al. Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med. 1999;159(18):2185–92. Epub 1999/10/20. PubMed PMID: 10527296.

    CAS  PubMed  Google Scholar 

  25. Tsiouris A, Horst HM, Paone G, Hodari A, Eichenhorn M, Rubinfeld I. Preoperative risk stratification for thoracic surgery using the American College of Surgeons National Surgical Quality Improvement Program data set: functional status predicts morbidity and mortality. J Surg Res. 2012;177(1):1–6. https://doi.org/10.1016/j.jss.2012.02.048. Epub 2012/04/10. PubMed PMID: 22484381.

    Article  PubMed  Google Scholar 

  26. Kertai MD, Bountioukos M, Boersma E, Bax JJ, Thomson IR, Sozzi F, et al. Aortic stenosis: an underestimated risk factor for perioperative complications in patients undergoing noncardiac surgery. Am J Med. 2004;116(1):8–13. PubMed PMID: 14706659.

    PubMed  Google Scholar 

  27. Jeger RV, Probst C, Arsenic R, Lippuner T, Pfisterer ME, Seeberger MD, et al. Long-term prognostic value of the preoperative 12-lead electrocardiogram before major noncardiac surgery in coronary artery disease. Am Heart J. 2006;151(2):508–13. https://doi.org/10.1016/j.ahj.2005.04.018. Epub 2006/01/31. PubMed PMID: 16442922.

    Article  PubMed  Google Scholar 

  28. Payne CJ, Payne AR, Gibson SC, Jardine AG, Berry C, Kingsmore DB. Is there still a role for preoperative 12-lead electrocardiography? World J Surg. 2011;35(12):2611–6. https://doi.org/10.1007/s00268-011-1289-y. Epub 2011/10/13. PubMed PMID: 21989644.

    Article  PubMed  Google Scholar 

  29. Kazmers A, Cerqueira MD, Zierler RE. Perioperative and late outcome in patients with left ventricular ejection fraction of 35% or less who require major vascular surgery. J Vasc Surg. 1988;8(3):307–15. Epub 1988/09/01. PubMed PMID: 3047443.

    CAS  PubMed  Google Scholar 

  30. Flu WJ, van Kuijk JP, Hoeks SE, Kuiper R, Schouten O, Goei D, et al. Prognostic implications of asymptomatic left ventricular dysfunction in patients undergoing vascular surgery. Anesthesiology. 2010;112(6):1316–24. https://doi.org/10.1097/ALN.0b013e3181da89ca. Epub 2010/05/27. PubMed PMID: 20502115.

    Article  PubMed  Google Scholar 

  31. Healy KO, Waksmonski CA, Altman RK, Stetson PD, Reyentovich A, Maurer MS. Perioperative outcome and long-term mortality for heart failure patients undergoing intermediate- and high-risk noncardiac surgery: impact of left ventricular ejection fraction. Congestive Heart Failure (Greenwich, Conn). 2010;16(2):45–9. https://doi.org/10.1111/j.1751-7133.2009.00130.x. Epub 2010/04/24. PubMed PMID: 20412467; PubMed Central PMCID: PMCPMC2945730.

    Article  Google Scholar 

  32. McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351(27):2795–804. PubMed PMID: 15625331.

    CAS  PubMed  Google Scholar 

  33. Poldermans D, Bax JJ, Schouten O, Neskovic AN, Paelinck B, Rocci G, et al. Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate control? J Am Coll Cardiol. 2006;48(5):964–9. PubMed PMID: 16949487.

    CAS  PubMed  Google Scholar 

  34. Arous EJ, Baum PL, Cutler BS. The ischemic exercise test in patients with peripheral vascular disease. Implications for management. Arch Surg. 1984;119(7):780–3. PubMed PMID: 6610402.

    CAS  PubMed  Google Scholar 

  35. Carliner NH, Fisher ML, Plotnick GD, Garbart H, Rapoport A, Kelemen MH, et al. Routine preoperative exercise testing in patients undergoing major noncardiac surgery. Am J Cardiol. 1985;56(1):51–8. PubMed PMID: 4014040.

    CAS  PubMed  Google Scholar 

  36. Cutler BS, Wheeler HB, Paraskos JA, Cardullo PA. Applicability and interpretation of electrocardiographic stress testing in patients with peripheral vascular disease. Am J Surg. 1981;141(4):501–6. PubMed PMID: 7223937.

    CAS  PubMed  Google Scholar 

  37. McPhail N, Calvin JE, Shariatmadar A, Barber GG, Scobie TK. The use of preoperative exercise testing to predict cardiac complications after arterial reconstruction. J Vasc Surg. 1988;7(1):60–8. PubMed PMID: 3336127.

    CAS  PubMed  Google Scholar 

  38. von Knorring J, Lepantalo M. Prediction of perioperative cardiac complications by electrocardiographic monitoring during treadmill exercise testing before peripheral vascular surgery. Surgery. 1986;99(5):610–3. PubMed PMID: 3704917.

    Google Scholar 

  39. Morris CK, Ueshima K, Kawaguchi T, Hideg A, Froelicher VF. The prognostic value of exercise capacity: a review of the literature. Am Heart J. 1991;122(5):1423–31. PubMed PMID: 1951007.

    CAS  PubMed  Google Scholar 

  40. Sgura FA, Kopecky SL, Grill JP, Gibbons RJ. Supine exercise capacity identifies patients at low risk for perioperative cardiovascular events and predicts long-term survival. Am J Med. 2000;108(4):334–6. Epub 2000/10/03. PubMed PMID: 11014727.

    CAS  PubMed  Google Scholar 

  41. Eichelberger JP, Schwarz KQ, Black ER, Green RM, Ouriel K. Predictive value of dobutamine echocardiography just before noncardiac vascular surgery. Am J Cardiol. 1993;72(7):602–7. Epub 1993/09/01. PubMed PMID: 8362778.

    CAS  PubMed  Google Scholar 

  42. Lalka SG, Sawada SG, Dalsing MC, Cikrit DF, Sawchuk AP, Kovacs RL, et al. Dobutamine stress echocardiography as a predictor of cardiac events associated with aortic surgery. J Vasc Surg. 1992;15(5):831–40; discussion 41–2. Epub 1992/05/01. PubMed PMID: 1578539.

    CAS  PubMed  Google Scholar 

  43. Lane RT, Sawada SG, Segar DS, Ryan T, Lalka SG, Williams R, et al. Dobutamine stress echocardiography for assessment of cardiac risk before noncardiac surgery. Am J Cardiol. 1991;68(9):976–7. Epub 1991/10/01. PubMed PMID: 1927965.

    CAS  PubMed  Google Scholar 

  44. Langan EM 3rd, Youkey JR, Franklin DP, Elmore JR, Costello JM, Nassef LA. Dobutamine stress echocardiography for cardiac risk assessment before aortic surgery. J Vasc Surg. 1993;18(6):905–11; discussion 12–3. Epub 1993/12/01. PubMed PMID: 8264046.

    PubMed  Google Scholar 

  45. Raux M, Godet G, Isnard R, Mergoni P, Goarin JP, Bertrand M, et al. Low negative predictive value of dobutamine stress echocardiography before abdominal aortic surgery. Br J Anaesth. 2006;97(6):770–6. https://doi.org/10.1093/bja/ael246. Epub 2006/09/16. PubMed PMID: 16973646.

    Article  CAS  PubMed  Google Scholar 

  46. Ballal RS, Kapadia S, Secknus MA, Rubin D, Arheart K, Marwick TH. Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography. Am Heart J. 1999;137(3):469–75. Epub 1999/02/27. PubMed PMID: 10047628.

    CAS  PubMed  Google Scholar 

  47. Mangano DT, London MJ, Tubau JF, Browner WS, Hollenberg M, Krupski W, et al. Dipyridamole thallium-201 scintigraphy as a preoperative screening test. A reexamination of its predictive potential. Study of Perioperative Ischemia Research Group. Circulation. 1991;84(2):493–502. Epub 1991/08/01. PubMed PMID: 1860194.

    CAS  PubMed  Google Scholar 

  48. Hendel RC, Whitfield SS, Villegas BJ, Cutler BS, Leppo JA. Prediction of late cardiac events by dipyridamole thallium imaging in patients undergoing elective vascular surgery. Am J Cardiol. 1992;70(15):1243–9. PubMed PMID: 1442573.

    CAS  PubMed  Google Scholar 

  49. Mantha S, Roizen MF, Barnard J, Thisted RA, Ellis JE, Foss J. Relative effectiveness of four preoperative tests for predicting adverse cardiac outcomes after vascular surgery: a meta-analysis. Anesth Analg. 1994;79(3):422–33. PubMed PMID: 8067544.

    CAS  PubMed  Google Scholar 

  50. Shaw LJ, Eagle KA, Gersh BJ, Miller DD. Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular surgery. J Am Coll Cardiol. 1996;27(4):787–98. PubMed PMID: 8613604.

    CAS  PubMed  Google Scholar 

  51. Kertai MD, Boersma E, Sicari R, L’Italien GJ, Bax JJ, Roelandt JR, et al. Which stress test is superior for perioperative cardiac risk stratification in patients undergoing major vascular surgery? Eur J Vasc Endovasc Surg. 2002;24(3):222–9. PubMed PMID: 12217283.

    CAS  PubMed  Google Scholar 

  52. Kertai MD, Boersma E, Bax JJ, Heijenbrok-Kal MH, Hunink MG, L’Talien GJ, et al. A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery. Heart. 2003;89(11):1327–34. Epub 2003/11/05. PubMed PMID: 14594892; PubMed Central PMCID: PMCPMC1767930.

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Beattie WS, Abdelnaem E, Wijeysundera DN, Buckley DN. A meta-analytic comparison of preoperative stress echocardiography and nuclear scintigraphy imaging. Anesth Analg. 2006;102(1):8–16. https://doi.org/10.1213/01.ane.0000189614.98906.43. Epub 2005/12/22. PubMed PMID: 16368798.

    Article  PubMed  Google Scholar 

  54. Boucher CA, Brewster DC, Darling RC, Okada RD, Strauss HW, Pohost GM. Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery. N Engl J Med. 1985;312(7):389–94. PubMed PMID: 3871502.

    CAS  PubMed  Google Scholar 

  55. Lette J, Waters D, Cerino M, Picard M, Champagne P, Lapointe J. Preoperative coronary artery disease risk stratification based on dipyridamole imaging and a simple three-step, three-segment model for patients undergoing noncardiac vascular surgery or major general surgery. Am J Cardiol. 1992;69(19):1553–8. PubMed PMID: 1598869.

    CAS  PubMed  Google Scholar 

  56. McEnroe CS, O’Donnell TF Jr, Yeager A, Konstam M, Mackey WC. Comparison of ejection fraction and Goldman risk factor analysis to dipyridamole-thallium 201 studies in the evaluation of cardiac morbidity after aortic aneurysm surgery. J Vasc Surg. 1990;11(4):497–504. PubMed PMID: 2325211.

    CAS  PubMed  Google Scholar 

  57. Shaw L, Miller DD, Kong BA, Hilton T, Stelken A, Stocke K, et al. Determination of perioperative cardiac risk by adenosine thallium-201 myocardial imaging. Am Heart J. 1992;124(4):861–9. PubMed PMID: 1529902.

    CAS  PubMed  Google Scholar 

  58. Kertai MD, Klein J, Bax JJ, Poldermans D. Predicting perioperative cardiac risk. Prog Cardiovasc Dis. 2005;47(4):240–57. PubMed PMID: 15991153.

    PubMed  Google Scholar 

  59. Brilakis ES, Orford JL, Fasseas P, Wilson SH, Melby S, Lennon RJ, et al. Outcome of patients undergoing balloon angioplasty in the two months prior to noncardiac surgery. Am J Cardiol. 2005;96(4):512–4. PubMed PMID: 16098302.

    PubMed  Google Scholar 

  60. Bossone E, Martinez FJ, Whyte RI, Iannettoni MD, Armstrong WF, Bach DS. Dobutamine stress echocardiography for the preoperative evaluation of patients undergoing lung volume reduction surgery. J Thorac Cardiovasc Surg. 1999;118(3):542–6. https://doi.org/10.1016/s0022-5223(99)70194-7. Epub 1999/09/02. PubMed PMID: 10469973.

    Article  CAS  PubMed  Google Scholar 

  61. Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, et al. Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting. J Am Coll Cardiol. 2003;42(2):234–40. PubMed PMID: 12875757.

    PubMed  Google Scholar 

  62. Babapulle MN, Joseph L, Belisle P, Brophy JM, Eisenberg MJ. A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet. 2004;364(9434):583–91. PubMed PMID: 15313358.

    CAS  PubMed  Google Scholar 

  63. Ahn JH, Park JR, Min JH, Sohn JT, Hwang SJ, Park Y, et al. Risk stratification using computed tomography coronary angiography in patients undergoing intermediate-risk noncardiac surgery. J Am Coll Cardiol. 2013;61(6):661–8. https://doi.org/10.1016/j.jacc.2012.09.060. Epub 2013/02/09. PubMed PMID: 23391198.

    Article  PubMed  Google Scholar 

  64. Fathala A. Coronary computed tomography angiography for risk stratification before noncardiac surgery. Ann Card Anaesth. 2016;19(1):31–7. https://doi.org/10.4103/0971-9784.173017. Epub 2016/01/12. PubMed PMID: 26750671; PubMed Central PMCID: PMCPMC4900383.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58(24):e44–122. https://doi.org/10.1016/j.jacc.2011.08.007. Epub 2011/11/11. PubMed PMID: 22070834.

    Article  PubMed  Google Scholar 

  66. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2012;143(1):4–34. https://doi.org/10.1016/j.jtcvs.2011.10.015. Epub 2011/12/17. PubMed PMID: 22172748.

    Article  PubMed  Google Scholar 

  67. Stone JG, Foex P, Sear JW, Johnson LL, Khambatta HJ, Triner L. Myocardial ischemia in untreated hypertensive patients: effect of a single small oral dose of a beta-adrenergic blocking agent. Anesthesiology. 1988;68(4):495–500. PubMed PMID: 2895596.

    CAS  PubMed  Google Scholar 

  68. Pasternack PF, Grossi EA, Baumann FG, Riles TS, Lamparello PJ, Giangola G, et al. Beta blockade to decrease silent myocardial ischemia during peripheral vascular surgery. Am J Surg. 1989;158(2):113–6. PubMed PMID: 2569274.

    CAS  PubMed  Google Scholar 

  69. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation. 2016;134(10):e123–55. https://doi.org/10.1161/cir.0000000000000404. Epub 2016/03/31. PubMed PMID: 27026020.

    Article  PubMed  Google Scholar 

  70. Pasternack PF, Imparato AM, Baumann FG, Laub G, Riles TS, Lamparello PJ, et al. The hemodynamics of beta-blockade in patients undergoing abdominal aortic aneurysm repair. Circulation. 1987;76(3 Pt 2):III1–7. PubMed PMID: 3621532.

    CAS  PubMed  Google Scholar 

  71. Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter study of perioperative Ischemia Research Group. N Engl J Med. 1996;335(23):1713–20. PubMed PMID: 8929262.

    CAS  PubMed  Google Scholar 

  72. Poldermans D, Boersma E, Bax JJ, Thomson IR, van de Ven LL, Blankensteijn JD, et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med. 1999;341(24):1789–94. https://doi.org/10.1056/nejm199912093412402. Epub 1999/12/10. PubMed PMID: 10588963.

    Article  CAS  PubMed  Google Scholar 

  73. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2006 guideline update for perioperative cardiovascular evaluation for noncardiac surgery: focused update on perioperative beta-blocker therapy—a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to update the 2002 guidelines on perioperative cardiovascular evaluation for noncardiac surgery). J Am Coll Cardiol. 2006;47(11):2343–55.

    PubMed  Google Scholar 

  74. Devereaux PJ, Beattie WS, Choi PT, Badner NH, Guyatt GH, Villar JC, et al. How strong is the evidence for the use of perioperative beta blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials. BMJ. 2005;331(7512):313–21. https://doi.org/10.1136/bmj.38503.623646.8F. Epub 2005/07/06. PubMed PMID: 15996966; PubMed Central PMCID: PMCPMC1183126.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Lindenauer PK, Pekow P, Wang K, Mamidi DK, Gutierrez B, Benjamin EM. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med. 2005;353(4):349–61. https://doi.org/10.1056/NEJMoa041895. Epub 2005/07/29. PubMed PMID: 16049209.

    Article  CAS  PubMed  Google Scholar 

  76. Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371(9627):1839–47. https://doi.org/10.1016/s0140-6736(08)60601-7. Epub 2008/05/16. PubMed PMID: 18479744.

    Article  CAS  PubMed  Google Scholar 

  77. Wijeysundera DN, Duncan D, Nkonde-Price C, Virani SS, Washam JB, Fleischmann KE, et al. Perioperative beta blockade in noncardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;64(22):2406–25. https://doi.org/10.1016/j.jacc.2014.07.939. Epub 2014/08/06. PubMed PMID: 25091545.

    Article  PubMed  Google Scholar 

  78. Shammash JB, Trost JC, Gold JM, Berlin JA, Golden MA, Kimmel SE. Perioperative beta-blocker withdrawal and mortality in vascular surgical patients. Am Heart J. 2001;141(1):148–53. https://doi.org/10.1067/mhj.2001.111547. Epub 2001/01/03. PubMed PMID: 11136500.

    Article  CAS  PubMed  Google Scholar 

  79. Hoeks SE, Scholte OP, Reimer WJ, van Urk H, Jorning PJ, Boersma E, Simoons ML, et al. Increase of 1-year mortality after perioperative beta-blocker withdrawal in endovascular and vascular surgery patients. Eur J Vasc Endovasc Surg. 2007;33(1):13–9. https://doi.org/10.1016/j.ejvs.2006.06.019. Epub 2006/08/29. PubMed PMID: 16935011.

    Article  CAS  PubMed  Google Scholar 

  80. Beattie WS, Wijeysundera DN, Karkouti K, McCluskey S, Tait G. Does tight heart rate control improve beta-blocker efficacy? An updated analysis of the noncardiac surgical randomized trials. Anesth Analg. 2008;106(4):1039–48. https://doi.org/10.1213/ane.0b013e318163f6a9. Epub 2008/03/20. PubMed PMID: 18349171.

    Article  CAS  PubMed  Google Scholar 

  81. Stevens RD, Burri H, Tramer MR. Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth Analg. 2003;97(3):623–33. PubMed PMID: 12933373.

    PubMed  Google Scholar 

  82. Wijeysundera DN, Beattie WS, Rao V, Karski J. Calcium antagonists reduce cardiovascular complications after cardiac surgery: a meta-analysis. J Am Coll Cardiol. 2003;41(9):1496–505. PubMed PMID: 12742289.

    CAS  PubMed  Google Scholar 

  83. Wijeysundera DN, Naik JS, Beattie WS. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med. 2003;114(9):742–52. PubMed PMID: 12829201.

    CAS  PubMed  Google Scholar 

  84. Wallace AW, Galindez D, Salahieh A, Layug EL, Lazo EA, Haratonik KA, et al. Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery. Anesthesiology. 2004;101(2):284–93. PubMed PMID: 15277909.

    CAS  PubMed  Google Scholar 

  85. Devereaux PJ, Sessler DI, Leslie K, Kurz A, Mrkobrada M, Alonso-Coello P, et al. Clonidine in patients undergoing noncardiac surgery. N Engl J Med. 2014;370(16):1504–13. https://doi.org/10.1056/NEJMoa1401106. Epub 2014/04/01. PubMed PMID: 24679061.

    Article  CAS  PubMed  Google Scholar 

  86. Comfere T, Sprung J, Kumar MM, Draper M, Wilson DP, Williams BA, et al. Angiotensin system inhibitors in a general surgical population. Anesth Analg. 2005;100(3):636–44, table of contents. PubMed PMID: 15728043.

    PubMed  Google Scholar 

  87. Kertai MD, Boersma E, Westerhout CM, Klein J, Van Urk H, Bax JJ, et al. A combination of statins and beta-blockers is independently associated with a reduction in the incidence of perioperative mortality and nonfatal myocardial infarction in patients undergoing abdominal aortic aneurysm surgery. Eur J Vasc Endovasc Surg. 2004;28(4):343–52. PubMed PMID: 15350554.

    CAS  PubMed  Google Scholar 

  88. Lindenauer PK, Pekow P, Wang K, Gutierrez B, Benjamin EM. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA. 2004;291(17):2092–9. PubMed PMID: 15126437.

    CAS  PubMed  Google Scholar 

  89. O’Neil-Callahan K, Katsimaglis G, Tepper MR, Ryan J, Mosby C, Ioannidis JP, et al. Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study. J Am Coll Cardiol. 2005;45(3):336–42. PubMed PMID: 15680709.

    PubMed  Google Scholar 

  90. Poldermans D, Bax JJ, Kertai MD, Krenning B, Westerhout CM, Schinkel AF, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation. 2003;107(14):1848–51. PubMed PMID: 12695283.

    CAS  PubMed  Google Scholar 

  91. Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA. 2001;285(13):1711–8. PubMed PMID: 11277825.

    CAS  PubMed  Google Scholar 

  92. Schouten O, Boersma E, Hoeks SE, Benner R, van Urk H, van Sambeek MR, et al. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med. 2009;361(10):980–9. https://doi.org/10.1056/NEJMoa0808207. Epub 2009/09/04. PubMed PMID: 19726772.

    Article  CAS  PubMed  Google Scholar 

  93. Sanders RD, Nicholson A, Lewis SR, Smith AF, Alderson P. Perioperative statin therapy for improving outcomes during and after noncardiac vascular surgery. Cochrane Database Syst Rev. 2013;7:CD009971. https://doi.org/10.1002/14651858.CD009971.pub2. Epub 2013/07/05. PubMed PMID: 23824754.

    Article  Google Scholar 

  94. Durazzo AE, Machado FS, Ikeoka DT, De Bernoche C, Monachini MC, Puech-Leao P, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 2004;39(5):967–75; discussion 75–6. https://doi.org/10.1016/j.jvs.2004.01.004. Epub 2004/04/28. PubMed PMID: 15111846.

  95. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49–73. https://doi.org/10.1161/01.cir.0000437741.48606.98. Epub 2013/11/14. PubMed PMID: 24222018.

    Article  PubMed  Google Scholar 

  96. Wijeysundera DN, Beattie WS. Calcium channel blockers for reducing cardiac morbidity after noncardiac surgery: a meta-analysis. Anesth Analg. 2003;97(3):634–41. Epub 2003/08/23. PubMed PMID: 12933374.

    CAS  PubMed  Google Scholar 

  97. Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg. 2001;93(4):853–8. PubMed PMID: 11574345.

    CAS  PubMed  Google Scholar 

  98. Turan A, You J, Shiba A, Kurz A, Saager L, Sessler DI. Angiotensin converting enzyme inhibitors are not associated with respiratory complications or mortality after noncardiac surgery. Anesth Analg. 2012;114(3):552–60. https://doi.org/10.1213/ANE.0b013e318241f6af. Epub 2012/01/19. PubMed PMID: 22253266.

    Article  CAS  PubMed  Google Scholar 

  99. Rosenman DJ, McDonald FS, Ebbert JO, Erwin PJ, LaBella M, Montori VM. Clinical consequences of withholding versus administering renin-angiotensin-aldosterone system antagonists in the preoperative period. J Hosp Med. 2008;3(4):319–25. https://doi.org/10.1002/jhm.323. Epub 2008/08/14. PubMed PMID: 18698608.

    Article  PubMed  Google Scholar 

  100. Brabant SM, Eyraud D, Bertrand M, Coriat P. Refractory hypotension after induction of anesthesia in a patient chronically treated with angiotensin receptor antagonists. Anesth Analg. 1999;89(4):887–8. PubMed PMID: 10512259.

    CAS  PubMed  Google Scholar 

  101. Brabant SM, Bertrand M, Eyraud D, Darmon PL, Coriat P. The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists. Anesth Analg. 1999;89(6):1388–92. PubMed PMID: 10589613.

    CAS  PubMed  Google Scholar 

  102. Bertrand M, Godet G, Meersschaert K, Brun L, Salcedo E, Coriat P. Should the angiotensin II antagonists be discontinued before surgery? Anesth Analg. 2001;92(1):26–30. PubMed PMID: 11133595.

    CAS  PubMed  Google Scholar 

  103. Twersky RS, Goel V, Narayan P, Weedon J. The risk of hypertension after preoperative discontinuation of angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists in ambulatory and same-day admission patients. Anesth Analg. 2014;118(5):938–44. https://doi.org/10.1213/ane.0000000000000076. Epub 2014/04/01. PubMed PMID: 24681657.

    Article  CAS  PubMed  Google Scholar 

  104. Hauser AM, Gangadharan V, Ramos RG, Gordon S, Timmis GC. Sequence of mechanical, electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: echocardiographic observations during coronary angioplasty. J Am Coll Cardiol. 1985;5(2 Pt 1):193–7. PubMed PMID: 3155758.

    CAS  PubMed  Google Scholar 

  105. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet. 2000;355(9212):1295–302. Epub 2000/04/25. PubMed PMID: 10776741.

    Google Scholar 

  106. Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P, Kurz A, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370(16):1494–503. https://doi.org/10.1056/NEJMoa1401105. Epub 2014/04/01. PubMed PMID: 24679062.

    Article  CAS  PubMed  Google Scholar 

  107. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016;68(10):1082–115. https://doi.org/10.1016/j.jacc.2016.03.513.

    Article  PubMed  Google Scholar 

  108. Wilson SH, Rihal CS, Bell MR, Velianou JL, Holmes DR Jr, Berger PB. Timing of coronary stent thrombosis in patients treated with ticlopidine and aspirin. Am J Cardiol. 1999;83(7):1006–11. Epub 1999/04/06. PubMed PMID: 10190510.

    CAS  PubMed  Google Scholar 

  109. Kaluza GL, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol. 2000;35(5):1288–94. Epub 2000/04/12. PubMed PMID: 10758971.

    CAS  PubMed  Google Scholar 

  110. Neill F, Sear JW, French G, Lam H, Kemp M, Hooper RJ, et al. Increases in serum concentrations of cardiac proteins and the prediction of early postoperative cardiovascular complications in noncardiac surgery patients. Anaesthesia. 2000;55(7):641–7. PubMed PMID: 10919418.

    CAS  PubMed  Google Scholar 

  111. Charlson ME, MacKenzie CR, Ales K, Gold JP, Fairclough G Jr, Shires GT. Surveillance for postoperative myocardial infarction after noncardiac operations. Surg Gynecol Obstet. 1988;167(5):407–14. PubMed PMID: 3175825.

    CAS  PubMed  Google Scholar 

  112. Eikelboom JW, Connolly SJ, Brueckmann M, Granger CB, Kappetein AP, Mack MJ, et al. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med. 2013;369(13):1206–14. https://doi.org/10.1056/NEJMoa1300615. Epub 2013/09/03. PubMed PMID: 23991661.

    Article  CAS  PubMed  Google Scholar 

  113. Doherty JU, Gluckman TJ, Hucker WJ, Januzzi JL Jr, Ortel TL, Saxonhouse SJ, et al. 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol. 2017;69(7):871–98. https://doi.org/10.1016/j.jacc.2016.11.024. Epub 2017/01/14. PubMed PMID: 28081965.

    Article  PubMed  Google Scholar 

  114. Raval AN, Cigarroa JE, Chung MK, Diaz-Sandoval LJ, Diercks D, Piccini JP, et al. Management of patients on non-vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting: a scientific statement from the American Heart Association. Circulation. 2017;135(10):e604–e33. https://doi.org/10.1161/cir.0000000000000477. Epub 2017/02/09. PubMed PMID: 28167634; PubMed Central PMCID: PMCPMC5404934.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  115. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):e521–643. https://doi.org/10.1161/cir.0000000000000031. Epub 2014/03/05. PubMed PMID: 24589853.

    Article  PubMed  Google Scholar 

  116. Goldman L. Aortic stenosis in noncardiac surgery: underappreciated in more ways than one? Am J Med. 2004;116(1):60–2. PubMed PMID: 14706670.

    PubMed  Google Scholar 

  117. O’Keefe JH Jr, Shub C, Rettke SR. Risk of noncardiac surgical procedures in patients with aortic stenosis. Mayo Clin Proc. 1989;64(4):400–5. PubMed PMID: 2716354.

    PubMed  Google Scholar 

  118. Parker MJ, Unwin SC, Handoll HH, Griffiths R. General versus spinal/epidural anaesthesia for surgery for hip fractures in adults. Cochrane Database Syst Rev. 2000;4:CD000521. PubMed PMID: 11034688.

    Google Scholar 

  119. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493. PubMed PMID: 11118174.

    CAS  PubMed  PubMed Central  Google Scholar 

  120. Baron JF, Bertrand M, Barre E, Godet G, Mundler O, Coriat P, et al. Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery. Anesthesiology. 1991;75(4):611–8. PubMed PMID: 1928770.

    CAS  PubMed  Google Scholar 

  121. Norris EJ, Beattie C, Perler BA, Martinez EA, Meinert CL, Anderson GF, et al. Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery. Anesthesiology. 2001;95(5):1054–67. PubMed PMID: 11684971.

    CAS  PubMed  Google Scholar 

  122. Nishimori M, Low JH, Zheng H, Ballantyne JC. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. 2012;7:CD005059. https://doi.org/10.1002/14651858.CD005059.pub3. Epub 2012/07/13. PubMed PMID: 22786494.

    Article  Google Scholar 

  123. Beattie WS, Badner NH, Choi PT. Meta-analysis demonstrates statistically significant reduction in postoperative myocardial infarction with the use of thoracic epidural analgesia. Anesth Analg. 2003;97(3):919–20. PubMed PMID: 12933434.

    PubMed  Google Scholar 

  124. Matot I, Oppenheim-Eden A, Ratrot R, Baranova J, Davidson E, Eylon S, et al. Preoperative cardiac events in elderly patients with hip fracture randomized to epidural or conventional analgesia. Anesthesiology. 2003;98(1):156–63. Epub 2002/12/28. PubMed PMID: 12502992.

    PubMed  Google Scholar 

  125. James FW, Kaplan S, Schwartz DC, Chou TC, Sandker MJ, Naylor V. Response to exercise in patients after total surgical correction of Tetralogy of Fallot. Circulation. 1976;54(4):671–9. PubMed PMID: 786502.

    CAS  PubMed  Google Scholar 

  126. Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348(1):5–14. PubMed PMID: 12510037.

    PubMed  Google Scholar 

  127. Haggmark S, Hohner P, Ostman M, Friedman A, Diamond G, Lowenstein E, et al. Comparison of hemodynamic, electrocardiographic, mechanical, and metabolic indicators of intraoperative myocardial ischemia in vascular surgical patients with coronary artery disease. Anesthesiology. 1989;70(1):19–25. PubMed PMID: 2912311.

    CAS  PubMed  Google Scholar 

  128. Eisenberg MJ, London MJ, Leung JM, Browner WS, Hollenberg M, Tubau JF, et al. Monitoring for myocardial ischemia during noncardiac surgery. A technology assessment of transesophageal echocardiography and 12-lead electrocardiography. The Study of Perioperative Ischemia Research Group. JAMA. 1992;268(2):210–6. PubMed PMID: 1608139.

    CAS  PubMed  Google Scholar 

  129. Sessler DI. Mild perioperative hypothermia. N Engl J Med. 1997;336(24):1730–7. PubMed PMID: 9180091.

    CAS  PubMed  Google Scholar 

  130. Frank SM, Higgins MS, Breslow MJ, Fleisher LA, Gorman RB, Sitzmann JV, et al. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial. Anesthesiology. 1995;82(1):83–93. PubMed PMID: 7832339.

    CAS  PubMed  Google Scholar 

  131. Frank SM, Higgins MS, Fleisher LA, Sitzmann JV, Raff H, Breslow MJ. Adrenergic, respiratory, and cardiovascular effects of core cooling in humans. Am J Phys. 1997;272(2 Pt 2):R557–62. PubMed PMID: 9124478.

    CAS  Google Scholar 

  132. Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277(14):1127–34. PubMed PMID: 9087467.

    CAS  PubMed  Google Scholar 

  133. Frank SM, Beattie C, Christopherson R, Norris EJ, Perler BA, Williams GM, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia. The Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology. 1993;78(3):468–76. PubMed PMID: 8457047.

    CAS  PubMed  Google Scholar 

  134. Nguyen HP, Zaroff JG, Bayman EO, Gelb AW, Todd MM, Hindman BJ. Perioperative hypothermia (33 degrees C) does not increase the occurrence of cardiovascular events in patients undergoing cerebral aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial. Anesthesiology. 2010;113(2):327–42. https://doi.org/10.1097/ALN.0b013e3181dfd4f7. Epub 2010/06/24. PubMed PMID: 20571361; PubMed Central PMCID: PMCPMC2910193.

    Article  PubMed  Google Scholar 

  135. Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. New England J Med. 2011;365(26):2453–62. https://doi.org/10.1056/NEJMoa1012452. Epub 2011/12/16. PubMed PMID: 22168590; PubMed Central PMCID: PMCPMC3268062.

    Article  CAS  Google Scholar 

  136. Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, et al. Red blood cell transfusion: a clinical practice guideline from the AABB∗. Ann Intern Med. 2012;157(1):49–58. https://doi.org/10.7326/0003-4819-157-1-201206190-00429. Epub 2012/07/04. PubMed PMID: 22751760.

    Article  PubMed  Google Scholar 

  137. Landesberg G, Mosseri M, Shatz V, Akopnik I, Bocher M, Mayer M, et al. Cardiac troponin after major vascular surgery: the role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization. J Am Coll Cardiol. 2004;44(3):569–75. PubMed PMID: 15358022.

    CAS  PubMed  Google Scholar 

  138. Rettke SR, Shub C, Naessens JM, Marsh HM, O’Brien JF. Significance of mildly elevated creatine kinase (myocardial band) activity after elective abdominal aortic aneurysmectomy. J Cardiothorac Vasc Anesth. 1991;5(5):425–30. PubMed PMID: 1932646.

    CAS  PubMed  Google Scholar 

  139. Devereaux PJ, Biccard BM, Sigamani A, Xavier D, Chan MTV, Srinathan SK, et al. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2017;317(16):1642–51. https://doi.org/10.1001/jama.2017.4360. Epub 2017/04/27. PubMed PMID: 28444280.

    Article  CAS  PubMed  Google Scholar 

  140. Duceppe E, Yusuf S, Tandon V, Rodseth R, Biccard BM, Xavier D, et al. Design of a randomized placebo-controlled trial to assess dabigatran and omeprazole in patients with Myocardial Injury after Noncardiac Surgery (MANAGE). Can J Cardiol. 2018;34(3):295–302. https://doi.org/10.1016/j.cjca.2018.01.020. Epub 2018/02/06. PubMed PMID: 29398173.

    Article  PubMed  Google Scholar 

  141. Rinfret S, Goldman L, Polanczyk CA, Cook EF, Lee TH. Value of immediate postoperative electrocardiogram to update risk stratification after major noncardiac surgery. Am J Cardiol. 2004;94(8):1017–22. https://doi.org/10.1016/j.amjcard.2004.06.057. Epub 2004/10/13. PubMed PMID: 15476615.

    Article  PubMed  Google Scholar 

  142. Devereaux PJ, Xavier D, Pogue J, Guyatt G, Sigamani A, Garutti I, et al. Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med. 2011;154(8):523–8. https://doi.org/10.7326/0003-4819-154-8-201104190-00003. Epub 2011/04/20. PubMed PMID: 21502650.

    Article  CAS  PubMed  Google Scholar 

  143. Agarwal S, Rajamanickam A, Bajaj NS, Griffin BP, Catacutan T, Svensson LG, et al. Impact of aortic stenosis on postoperative outcomes after noncardiac surgeries. Circ Cardiovasc Qual Outcomes. 2013;6(2):193–200. https://doi.org/10.1161/circoutcomes.111.000091. Epub 2013/03/14. PubMed PMID: 23481524.

    Article  PubMed  Google Scholar 

  144. Roth RB, Palacios IF, Block PC. Percutaneous aortic balloon valvuloplasty: its role in the management of patients with aortic stenosis requiring major noncardiac surgery. J Am Coll Cardiol. 1989;13(5):1039–41. Epub 1989/04/01. PubMed PMID: 2926053.

    CAS  PubMed  Google Scholar 

  145. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607. https://doi.org/10.1056/NEJMoa1008232. Epub 2010/10/22. PubMed PMID: 20961243.

    Article  CAS  PubMed  Google Scholar 

  146. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98. https://doi.org/10.1056/NEJMoa1103510. Epub 2011/06/07. PubMed PMID: 21639811.

    Article  CAS  PubMed  Google Scholar 

  147. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20. https://doi.org/10.1056/NEJMoa1514616. Epub 2016/04/05. PubMed PMID: 27040324.

    Article  CAS  PubMed  Google Scholar 

  148. Reyes VP, Raju BS, Wynne J, Stephenson LW, Raju R, Fromm BS, et al. Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis. N Engl J Med. 1994;331(15):961–7. https://doi.org/10.1056/nejm199410133311501. Epub 1994/10/13. PubMed PMID: 8084354.

    Article  CAS  PubMed  Google Scholar 

  149. Goldman L, Caldera DL, Southwick FS, Nussbaum SR, Murray B, O’Malley TA, et al. Cardiac risk factors and complications in non-cardiac surgery. Medicine (Baltimore). 1978;57(4):357–70. PubMed PMID: 661558.

    CAS  Google Scholar 

  150. Mahla E, Rotman B, Rehak P, Atlee JL, Gombotz H, Berger J, et al. Perioperative ventricular dysrhythmias in patients with structural heart disease undergoing noncardiac surgery. Anesth Analg. 1998;86(1):16–21. Epub 1998/01/16. PubMed PMID: 9428844.

    CAS  PubMed  Google Scholar 

  151. Pastore JO, Yurchak PM, Janis KM, Murphy JD, Zir LM. The risk of advanced heart block in surgical patients with right bundle branch block and left axis deviation. Circulation. 1978;57(4):677–80. Epub 1978/04/01. PubMed PMID: 630675.

    CAS  PubMed  Google Scholar 

  152. Heller LI. Surgical electrocautery and the runaway pacemaker syndrome. Pacing Clin Electrophysiol. 1990;13(9):1084–5. Epub 1990/09/01. PubMed PMID: 1700378.

    CAS  PubMed  Google Scholar 

  153. Mangar D, Atlas GM, Kane PB. Electrocautery-induced pacemaker malfunction during surgery. Can J Anaesth. 1991;38(5):616–8. https://doi.org/10.1007/bf03008198. Epub 1991/07/01. PubMed PMID: 1934215.

    Article  CAS  PubMed  Google Scholar 

  154. Cheng A, Nazarian S, Spragg DD, Bilchick K, Tandri H, Mark L, et al. Effects of surgical and endoscopic electrocautery on modern-day permanent pacemaker and implantable cardioverter-defibrillator systems. Pacing Clin Electrophysiol. 2008;31(3):344–50. https://doi.org/10.1111/j.1540-8159.2008.00996.x. Epub 2008/03/01. PubMed PMID: 18307631.

    Article  PubMed  Google Scholar 

  155. Guertin D, Faheem O, Ling T, Pelletier G, McComas D, Yarlagadda RK, et al. Electromagnetic Interference (EMI) and arrhythmic events in ICD patients undergoing gastrointestinal procedures. Pacing Clin Electrophysiol. 2007;30(6):734–9. https://doi.org/10.1111/j.1540-8159.2007.00743.x. Epub 2007/06/06. PubMed PMID: 17547605.

    Article  PubMed  Google Scholar 

  156. Stone ME, Salter B, Fischer A. Perioperative management of patients with cardiac implantable electronic devices. Br J Anaesth. 2011;107(Suppl 1):i16–26. https://doi.org/10.1093/bja/aer354. Epub 2011/12/22. PubMed PMID: 22156267.

    Article  PubMed  Google Scholar 

  157. Mahlow WJ, Craft RM, Misulia NL, Cox JW Jr, Hirsh JB, Snider CC, et al. A perioperative management algorithm for cardiac rhythm management devices: the PACED-OP protocol. Pacing Clin Electrophysiol. 2013;36(2):238–48. https://doi.org/10.1111/pace.12049. Epub 2012/12/21. PubMed PMID: 23252749.

    Article  PubMed  Google Scholar 

  158. Crossley GH, Poole JE, Rozner MA, Asirvatham SJ, Cheng A, Chung MK, et al. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm. 2011;8(7):1114–54. https://doi.org/10.1016/j.hrthm.2010.12.023. Epub 2011/07/05. PubMed PMID: 21722856.

    Article  PubMed  Google Scholar 

  159. Detsky AS, Abrams HB, McLaughlin JR, Drucker DJ, Sasson Z, Johnston N, et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med. 1986;1(4):211–9. PubMed PMID: 3772593.

    CAS  PubMed  Google Scholar 

  160. van Diepen S, Bakal JA, McAlister FA, Ezekowitz JA. Mortality and readmission of patients with heart failure, atrial fibrillation, or coronary artery disease undergoing noncardiac surgery: an analysis of 38 047 patients. Circulation. 2011;124(3):289–96. https://doi.org/10.1161/circulationaha.110.011130. Epub 2011/06/29. PubMed PMID: 21709059.

    Article  PubMed  Google Scholar 

  161. Xu-Cai YO, Brotman DJ, Phillips CO, Michota FA, Tang WH, Whinney CM, et al. Outcomes of patients with stable heart failure undergoing elective noncardiac surgery. Mayo Clin Proc. 2008;83(3):280–8. https://doi.org/10.4065/83.3.280. Epub 2008/03/05. PubMed PMID: 18315993.

    Article  PubMed  Google Scholar 

  162. Lai HC, Lai HC, Wang KY, Lee WL, Ting CT, Liu TJ. Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. Br J Anaesth. 2007;99(2):184–90. https://doi.org/10.1093/bja/aem126. Epub 2007/06/20. PubMed PMID: 17576968.

    Article  PubMed  Google Scholar 

  163. Price LC, Montani D, Jais X, Dick JR, Simonneau G, Sitbon O, et al. Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension. Eur Respir J. 2010;35(6):1294–302. https://doi.org/10.1183/09031936.00113009. Epub 2009/11/10. PubMed PMID: 19897552.

    Article  CAS  PubMed  Google Scholar 

  164. Minai OA, Venkateshiah SB, Arroliga AC. Surgical intervention in patients with moderate to severe pulmonary arterial hypertension. Conn Med. 2006;70(4):239–43. Epub 2006/06/14. PubMed PMID: 16768070.

    PubMed  Google Scholar 

  165. Ramakrishna G, Sprung J, Ravi BS, Chandrasekaran K, McGoon MD. Impact of pulmonary hypertension on the outcomes of noncardiac surgery: predictors of perioperative morbidity and mortality. J Am Coll Cardiol. 2005;45(10):1691–9. https://doi.org/10.1016/j.jacc.2005.02.055. Epub 2005/05/17. PubMed PMID: 15893189.

    Article  PubMed  Google Scholar 

  166. Minai OA, Yared JP, Kaw R, Subramaniam K, Hill NS. Perioperative risk and management in patients with pulmonary hypertension. Chest. 2013;144(1):329–40. https://doi.org/10.1378/chest.12-1752. Epub 2013/07/25. PubMed PMID: 23880683.

    Article  PubMed  Google Scholar 

  167. Thompson RC, Liberthson RR, Lowenstein E. Perioperative anesthetic risk of noncardiac surgery in hypertrophic obstructive cardiomyopathy. JAMA. 1985;254(17):2419–21. PubMed PMID: 4046165.

    CAS  PubMed  Google Scholar 

  168. Haering JM, Comunale ME, Parker RA, Lowenstein E, Douglas PS, Krumholz HM, et al. Cardiac risk of noncardiac surgery in patients with asymmetric septal hypertrophy. Anesthesiology. 1996;85(2):254–9. PubMed PMID: 8712439.

    CAS  PubMed  Google Scholar 

  169. Tikoff G, Keith TB, Nelson RM, Kuida H. Clinical and hemodynamic observations after surgical closure of large atrial septal defect complicated by heart failure. Am J Cardiol. 1969;23(6):810–7. PubMed PMID: 5785160.

    CAS  PubMed  Google Scholar 

  170. Lueker RD, Vogel JH, Blount SG Jr. Cardiovascular abnormalities following surgery for left-to-right shunts. Observations in atrial septal defects, ventricular septal defects, and patent ductus arteriosus. Circulation. 1969;40(6):785–801. PubMed PMID: 5387357.

    CAS  PubMed  Google Scholar 

  171. Maron BJ, Humphries JO, Rowe RD, Mellits ED. Prognosis of surgically corrected coarctation of the aorta. A 20-year postoperative appraisal. Circulation. 1973;47(1):119–26. PubMed PMID: 4686589.

    CAS  PubMed  Google Scholar 

  172. Simon AB, Zloto AE. Coarctation of the aorta. Longitudinal assessment of operated patients. Circulation. 1974;50(3):456–64. PubMed PMID: 4278034.

    CAS  PubMed  Google Scholar 

  173. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118(23):e714–833. https://doi.org/10.1161/circulationaha.108.190690. Epub 2008/11/11. PubMed PMID: 18997169.

    Article  PubMed  Google Scholar 

  174. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation. 2002;105(10):1257–67. Epub 2002/03/13. PubMed PMID: 11889023.

    PubMed  Google Scholar 

  175. Paul SD, Eagle KA. A stepwise strategy for coronary risk assessment for noncardiac surgery. Med Clin North Am. 1995;79(5):1241–62. Epub 1995/09/01. PubMed PMID: 7674693.

    CAS  PubMed  Google Scholar 

  176. Mehta RH, Bossone E, Eagle KA. Perioperative cardiac risk assessment for noncardiac surgery. Cardiologia (Rome, Italy). 1999;44(5):409–18. Epub 1999/07/02. PubMed PMID: 10389344.

    CAS  Google Scholar 

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Vallakati, A., Baliga, R.R., Eagle, K.A. (2020). Perioperative Evaluation and Management of Patients Undergoing Noncardiac Surgery. In: Baliga, R., Eagle, K. (eds) Practical Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-28328-5_33

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