People with heart disease should take special precautions before undergoing all operations, even noncardiac surgery, to reduce their risk of a cardiac event, according to new joint guidelines issued by the American College of Cardiology and the American Heart Association. The guidelines update those from 2002. Some of the new recommendations are as follows :
•Patients should not stop taking cholesterol-lowering drugs before surgery.
•Many heart patients can safely have noncardiac surgery without first correcting their heart disease with an artery-opening procedure or coronary bypass grafting.
•For non-emergency procedures, bypass surgery or angioplasty is rarely necessary to lower the risk of surgery unless the patient needs the intervention anyway.
•If the noncardiac surgery is an emergency, heart testing should be forgone and patients should be taken straight to the operating room.
Patients should be evaluated and treated before noncardiac surgery only for active cardiac conditions such as severe angina, decompensated heart failure, significant arrhythmias, and severe heart valve disease.
•Patients needing elective noncardiac surgery and an artery-opening procedure beforehand should receive angioplasty with a bare metal stent, followed by four to six weeks of anticlotting therapy.
•For patients with a drug-eluting coronary stent who need urgent noncardiac surgery that requires stopping the prescription anticlotting drug, aspirin therapy should continue, if feasible; prescription medication should be restarted as soon as possible.
•Patients with two or more blocked blood vessels, unstable angina, or heart attack symptoms should have coronary artery bypass grafting or angioplasty before undergoing non-cardiac surgery.
•Preoperative testing should be limited to circumstances in which test results would affect treatment.
(Source: Circulation, September 27 and October 23, 2007.)