J.Jpn. Surg. Soc.. 106(5): 328-333, 2005

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Feature topic

PERIOPERATIVE CARDIOVASCULAR EVALUATION AND MANAGEMENT FOR NON-CARDIAC SURGERY IN PATIENTS WITH VALVULAR HEART DISEASE

A significant perioperative cardiac morbidity and mortality should be anticipated during non-cardiac surgery when patients have cardiac risks. Especially the non-cardiac surgical risk is very high in the patient with aortic stenosis. Non-cardiac surgery should be postponed to cardiac interventions, such as balloon valvuloplasty or prosthetic valve replacement, in patients with severe heart failure. Non-cardiac surgery can be performed with a relatively low risk even if the patients have a symptomatic regurgitatant valvular heart diseases, however, the cardiac risk is always very high in the patients with left ventricular ejection fraction lowerer than 40%. Surgical invasion, anesthetic agents, analgegic agents, and fluid transfusion during the non-cardiac surgery will give a significant effects on the circulatory condition, therefore, non-cardiac surgery should be performed with an adequate cardiac monitoring and careful perioperarive managements according to the pathophysiology of each valvular heart disaease. Afterload control is very important in the patients with regurgitant valvular heart diseases, contrary preload control is very important in the patients with stenotic valvular heart diseases. Anesthetic agents and methods are not the determinant factor of the clinical outcome, but the associated cardiac diseases and the surgical procedure are important determinant factor of the clinical outcome of the non-cardiac surgery.

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