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To understand the principles of assessment by type of non-cardiac surgery, the Revised Cardiac Index Risk score, the grade of valve disease and functional capacity.
To understand that adverse events at non-cardiac surgery result from associated coronary disease and the haemodynamic effects of the valve disease.
To understand the precautions necessary during and after non-cardiac surgery and when invasive intervention is indicated in severe aortic stenosis or mitral stenosis.
Valve disease is a major concern in patients having non-cardiac surgery. First, it is common (table 1)1–4 particularly in the elderly who may also have other comorbidities. The adult population prevalence of moderate or severe disease is 2.5% and this rises to >13% in people aged ≥75.1 Second, valve disease is often asymptomatic and may be detected for the first time during preoperative assessment for non-cardiac surgery. In the OxVALVE community study,3 moderate or severe valve disease was known in 4.9% people aged >65 and was newly detected by screening in a further 6.4%. Third, valve disease, particularly aortic stenosis (AS), may be associated with coronary disease which contributes to the perioperative risk.5 Fourth, recognised competencies in heart valve disease6 7 are not universal in all disciplines caring for patients having non-cardiac surgery. Finally, the evidence base is small. A combination of these factors leads to anxiety over the presence of valve disease although this is often misplaced.
This article discusses the assessment and perioperative management of patients with heart valve disease including replacement valves.
An approach to valve disease
If emergency life-saving surgery is needed, this should proceed immediately (figure 1).8–11 If severe valve disease is known or suspected from the history or the presence of a significant murmur, additional precautions should be taken in perioperative care (box 1).
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