TY - JOUR T1 - Valve disease and non-cardiac surgery JF - Heart JO - Heart SP - 1878 LP - 1887 DO - 10.1136/heartjnl-2017-312455 VL - 104 IS - 22 AU - John B Chambers Y1 - 2018/11/01 UR - http://heart.bmj.com/content/104/22/1878.abstract N2 - Learning objectivesTo 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.View this table:In this windowIn a new windowTable 1 Prevalence (%) of moderate or severe valve diseaseThis article discusses the assessment and perioperative management of patients with heart valve disease including replacement valves.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).Figure 1 An approach to valve disease. … ER -