J.Jpn. Surg. Soc.. 106(5): 323-327, 2005

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Feature topic

PREOPERATIVE EVALUATION AND MANAGEMENT OF PATIENTS WITH ISCHEMIC HEART DISEASE UNDERGOING NONCARDIAC SURGERY

The evaluation and management of patients with coronary artery disease (CAD) undergoing noncardiac surgery are becoming important medical issues in modern society with the aging of the population and prevalence of CAD. For patients with CAD, medical therapy (beta-blockers, statins), percutaneous coronary artery intervention (PCI) with/without stenting, and coronary artery bypass grafting have been the modalities for management. Although balloon angioplasty is effective in selected patients, bare-metal stents (BMS) require post-PCI antiplatelet therapy for 4-6 weeks, delaying noncardiac procedures. As recently reported, patients with drug-eluting stents (DES) experienced late stentthrombosis due to discontinuation of antiplatelet therapy in the long-term period before noncardiac surgery, suggesting the need for life-long anticoagulant therapy after DES placement. Recently, offpump coronary artery bypass (OPCAB) has become a safe and effective procedure for direct coronary revascularization. OPCAB, without cardiopulmonary bypass and its adverse effects, can be performed simultaneously with noncardiac surgery such as carotid endoarterectomy, abdominal aortic aneurysm resection, and peripheral arterial reconstruction. OPCAB is a promising option as a simultaneous or staged procedure for patients with CAD and noncardiac disease.

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