Sandbox:AHAPrince

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

Class I
"1. It is recommended that patients with clinically suspected moderate or greater degrees of valvular stenosis or regurgitation undergo preoperative echocardiography if there has been either 1) no prior echocardiography within 1 year or 2) a significant change in clinical status or physical examination since last evaluation(Level of Evidence: C)"
"2. . For adults who meet standard indications for valvular intervention (replacement and repair) on the basis of symptoms and severity of stenosis or regurgitation, valvular intervention before elective noncardiac surgery is effective in reducing perioperative risk(Level of Evidence: C)"

Class IIa
"1. Elevated-risk elective noncardiac surgery with appropriate intraoperative and postoperative hemodynamic monitoring is reasonable to perform in patients with asymptomatic severe aortic stenosis (Level of Evidence: B)"
"2. . Elevated-risk elective noncardiac surgery with appropriate intraoperative and postoperative hemodynamic monitoring is reasonable in adults with asymptomatic severe MR (Level of Evidence: C)"
"3. Elevated-risk elective noncardiac surgery with appropriate intraoperative and postoperative hemodynamic monitoring is reasonable in adults with asymptomatic severe aortic regurgitation and a normal left ventricular ejection fraction (Level of Evidence: C)"

Class IIb
"1. . Elevated-risk elective noncardiac surgery using appropriate intraoperative and postoperative hemodynamic monitoring may be reasonable in asymptomatic patients with severe mitral stenosis if valve morphology is not favorable for percutaneous mitral balloon commissurotomy. (Level of Evidence: C)"

Class I
"1. Before elective surgery in a patient with a CIED, the surgical/procedure team and clinician following the CIED should communicate in advance to plan perioperative management of the CIED.(Level of Evidence: C)"
"2.Chronic pulmonary vascular targeted therapy (i.e., phosphodiesterase type 5 inhibitors, soluble guanylate cyclase stimulators, endothelin receptor antagonists, and prostanoids) should be continued unless contraindicated or not tolerated in patients with pulmonary hypertension who are undergoing noncardiac surgery.(Level of Evidence: C)"

Class IIa
"1. Unless the risks of delay outweigh the potential benefits, preoperative evaluation by a pulmonary hypertension specialist before noncardiac surgery can be beneficial for patients with pulmonary hypertension, particularly for those with features of increased perioperative risk (Level of Evidence: C)"

Class IIa
"1. A validated risk-prediction tool can be useful in predicting the risk of perioperative MACE in patients undergoing noncardiac surgery (Level of Evidence: B)"

Class III (No Benefit)
"1.For patients with a low risk of perioperative MACE, further testing is not recommended before the planned operation (Level of Evidence: B)"

Class IIa
"1. . Preoperative resting 12-lead electrocardiogram (ECG) is reasonable for patients with known coronary heart disease, significant arrhythmia, peripheral arterial disease, cerebrovascular disease, or other significant structural heart disease, except for those undergoing low-risk surgery (Level of Evidence: B)"

Class IIb
"1. Preoperative resting 12-lead ECG may be considered for asymptomatic patients without known coronary heart disease, except for those undergoing low-risk surgery (Level of Evidence: B)"

Class III (No Benefit)
"1. Routine preoperative resting 12-lead ECG is not useful for asymptomatic patients undergoing low-risk surgical procedures (Level of Evidence: B)"

Class IIa
"1. . It is reasonable for patients with dyspnea of unknown origin to undergo preoperative evaluation of left ventricular (LV) function (Level of Evidence: C)"
"2. It is reasonable for patients with heart failure (HF) with worsening dyspnea or other change in clinical status to undergo preoperative evaluation of LV function. (Level of Evidence: C)"

Class IIb
"1. Reassessment of LV function in clinically stable patients with previously documented LV dysfunction may be considered if there has been no assessment within a year (Level of Evidence: C)"

Class III (No Benefit)
"1. Routine preoperative evaluation of LV function is not recommended (Level of Evidence: B)"

Class IIa
"1. RECOMMENDATION 1 HERE (Level of Evidence: C)"
"2. RECOMMENDATION 2 HERE (Level of Evidence: C)"

Class IIb
"1. RECOMMENDATION 1 HERE (Level of Evidence: C)"
"2. RECOMMENDATION 2 HERE (Level of Evidence: C)"

Class III (No Benefit)
"1. RECOMMENDATION 1 HERE (Level of Evidence: C)"
"2. RECOMMENDATION 2 HERE (Level of Evidence: C)"