[Perioperative Management for Patients with Cardiovascular Diseases in General Thoracic Surgery].

ABSTRACT

For general thoracic surgeons, perioperative management for the prevention of cardiac complications is important because patients undergoing general thoracic surgery often have risk factors for cardiac diseases. Some risk-scoring systems can estimate a patient's risk of perioperative cardiac complication. Surgery-specific risk for intrathoracic surgery is intermediate. Preoperative evaluation for coronary artery disease should be considered only in high-risk patients based on the risk-scoring system and surgery- specific risk. If coronary artery disease is detected in a preoperative patient, the treatment, such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) should not be preoperatively performed as much as possible, because it requires antithrombotic therapy for at least a couple of months and may cause a delay for general thoracic surgical treatment. In high-risk patients for perioperative coronary artery disease, the 12-lead electrocardiogram is recommended for part of routine clinical care during the early postoperative period. The development of perioperative heart failure after noncardiac surgery is a high risk of operative mortality and hospital readmission. Transthoracic echocardiography should not be routinely performed as a preoperative examination, it can help detect underlying heart failure and valvular diseases and contribute to more appropriate postoperative management. Frequent monitoring of vital signs, oxygen saturation, and chest X-rays are important for the early detection of postoperative heart failure.