[What pre-operative explorations should be performed in a cardiac patient scheduled for non cardiological surgery?]

Abstract

In general, preoperative assessment of cardiac patients undergoing non-cardiac surgery relies on thorough clinical evaluation and rest EKG associated if necessary with further examination. In the case of coronary failure, coronary artery disease is the pathology most frequently encountered and is worrying because of the severe complications it provokes. Modern care of such patients requires a thorough study of clinical risk factors as well as pre-test probability of post-operative complications. This will enable one to quantify the cardiac risk and to work out the best strategy for pre-operative examinations in a restricted budgetary context. If the cardiac risk is low, no special pre-operative planning is necessary. On the contrary, a higher cardiac risk (institution dependent) renders relevant invasive exams necessary, such as radionuclide angiography and stress echocardiography. Positive testing leads to coronary angiography. If the latter reveals severe coronary stenosis, bypass grafting or percutaneous angioplasty is required if its risk does not exceed the patient's present post-operative complication rate for the scheduled surgery. For the other cardiac pathologies, echocardiography is the leading exam to assess left ventricular failure or valvular pathologies. New York Heart Association and Duke University classifications help in the risk stratification of such patients.