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Perioperative Evaluation

The purpose of the cardiologist’s assessment of patients scheduled for surgery is to determine the perioperative risk and to determine the need for additional examinations or improvements in the patient’s treatment. It is extremely important that the patient’s state of health is optimal before surgery. Studies have shown that about 40% of intraoperative complications are related to cardiovascular events.

Risk assessment does not only depend on the cardiologist but is a team effort with good interdisciplinary collaboration. The involvement of the patient and the family in the decision-making process is very important. Preoperative evaluation can modify the surgical procedure, the type of anesthesia and even delay or cancel the operation if necessary.

According to the guidelines of the European Society of Cardiology, important factors that must be determined are 1) whether the operation is urgent and 2) whether the patient has a heart disease. The intraoperative risk for cardiovascular events is determined by the following:

  • The type and duration of surgery
    • Surgeries involving large vessels of the body or are of long duration have a significantly higher risk than a laparoscopic operation.
    • In emergencies the cardiological evaluation can be done a few hours before while in scheduled surgeries it would be right to do the cardiac evaluation in a reasonable time before the operation.
  • Functional ability of the patient
    • A good to very good ability to exercise is associated with good prognostic value in patients undergoing surgery even in patients with stable coronary heart disease
    • Various indicators and algorithms are designed to quantify the patient’s functional ability.
  • Risk factors
    • Diabetes mellitus
    • Hypertension
    • Coronary heart disease
    • High cholesterol
    • Smoking
    • History of Stroke
    • Heart failure
    • Valve disease
    • Arrhythmias
    • Pulmonary hypertension
    • Peripheral arterial disease

The role of the cardiologist is to determine the severity of heart disease, whether it is coronary heart disease or valvular disease, using echocardiography and non-invasive functional tests such as the stress test.

Based on the results of these tests, the cardiologist may suggest therapeutic solutions that may involve invasive treatment such as percutaneous coronary artery bypass grafting (PCI) or coronary artery bypass graft surgery (CABG) or optimization of medication.

Please contact us in case you need personalized detailed clarifications. This evaluation can be done in our office.

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