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Management of Patients With Heart Disease for Noncardiac Surgery FREE

John H. Tinker, MD; Carl R. Noback, MD; Ronald E. Vlietstra, MD; Robert L. Frye, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to Department of Anesthesiology, Mayo Clinic and Medical School, Rochester, MN 55455 (Dr Tinker).


JAMA. 1981;246(12):1348-1350. doi:10.1001/jama.1981.03320120050031
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PHYSICIANS are frequently consulted about the advisability and perioperative management of noncardiac surgery in patients with heart disease. The risks in patients with coronary artery disease have been extensively studied, whereas other types of heart disease, perhaps because of their more uniformly progressive nature, have not proved as amenable to specific risk analysis. Clinical judgment remains central to the assessment of the risk-benefit ratio of any proposed procedure. We intend to present briefly considerations of risk, preoperative pharmacologic management, and a discussion of basic principles of operative and postoperative care.

Risk of Noncardiac Surgery in Patients With Coronary Artery Disease 

Prior Myocardial Infarction.—  Several retrospective studies have shown that patients with a prior myocardial infarction (MI) have about a 6% incidence of new infarction occurring within seven days of anesthesia and surgery, unless the prior MI was recent.1-3 Operations performed within three months of an MI are associated with

REFERENCES

Tarhan S, Moffitt EA, Taylor WF, et al:  Myocardial infarction after general anesthesia . JAMA 1972;;220:1451-1454.
Steen PA, Tinker JH, Tarhan S:  Myocardial reinfarction after anesthesia and surgery . JAMA 1978;;239:2566-2570.
Topkins MJ, Artusio JF:  Myocardial infarctions and surgery, a five year study . Anesth Analg 1964;;23:716-720.
Goldman L, Caldera DL, Nussbaum SR, et al:  Multifactorial index of cardiac risk in noncardiac surgical procedures . N Engl J Med 1977;;297:845-850.
Backer CL, Tinker JH, Robertson DM, et al:  Myocardial reinfarction following local anesthesia for ophthalmic surgery . Anesth Analg 1980;; 59:257-262.
Mahar LJ, Steen PA, Tinker JH, et al:  Perioperative myocardial infarction in patients with coronary artery disease with and without aorta-coronary artery bypass grafts . J Thorac Cardiovasc Surg 1978;;76:533-537.
Beahrs MM, Olney BA, Tajik AJ, et al:  Pulmonary atresia with ventricular septal defect in adults: Clinical profile, diagnosis, management, and follow-up in 84 cases , abstracted. Circulation 1979;;60( (suppl 2) ):251.
Pastore JO, Urchak PM, Janis KM, et al:  The risk of advanced heart block in surgical patients with right bundle-branch block and left axis deviation . Circulation 1978;;57:677-680.
Tinker JH, Tarhan S:  Discontinuing anticoagulant therapy in surgical patients with cardiac valve prostheses: Observations in 180 operations . JAMA 1978;;239:738-739.
 Prevention of bacterial endocarditis, Committee on Rheumatic Fever and Bacterial Endocarditis . Circulation 1977;;56:139A-143A.
Loeb HS, Sandje A, Croke RP, et al:  Effects of pharmacologically-induced hypertension on myocardial ischemia and coronary hemodynamics in patients with fixed coronary obstruction . Circulation 1978;;57:41-46.

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Tarhan S, Moffitt EA, Taylor WF, et al:  Myocardial infarction after general anesthesia . JAMA 1972;;220:1451-1454.
Steen PA, Tinker JH, Tarhan S:  Myocardial reinfarction after anesthesia and surgery . JAMA 1978;;239:2566-2570.
Topkins MJ, Artusio JF:  Myocardial infarctions and surgery, a five year study . Anesth Analg 1964;;23:716-720.
Goldman L, Caldera DL, Nussbaum SR, et al:  Multifactorial index of cardiac risk in noncardiac surgical procedures . N Engl J Med 1977;;297:845-850.
Backer CL, Tinker JH, Robertson DM, et al:  Myocardial reinfarction following local anesthesia for ophthalmic surgery . Anesth Analg 1980;; 59:257-262.
Mahar LJ, Steen PA, Tinker JH, et al:  Perioperative myocardial infarction in patients with coronary artery disease with and without aorta-coronary artery bypass grafts . J Thorac Cardiovasc Surg 1978;;76:533-537.
Beahrs MM, Olney BA, Tajik AJ, et al:  Pulmonary atresia with ventricular septal defect in adults: Clinical profile, diagnosis, management, and follow-up in 84 cases , abstracted. Circulation 1979;;60( (suppl 2) ):251.
Pastore JO, Urchak PM, Janis KM, et al:  The risk of advanced heart block in surgical patients with right bundle-branch block and left axis deviation . Circulation 1978;;57:677-680.
Tinker JH, Tarhan S:  Discontinuing anticoagulant therapy in surgical patients with cardiac valve prostheses: Observations in 180 operations . JAMA 1978;;239:738-739.
 Prevention of bacterial endocarditis, Committee on Rheumatic Fever and Bacterial Endocarditis . Circulation 1977;;56:139A-143A.
Loeb HS, Sandje A, Croke RP, et al:  Effects of pharmacologically-induced hypertension on myocardial ischemia and coronary hemodynamics in patients with fixed coronary obstruction . Circulation 1978;;57:41-46.
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