Timing surgery around cardiovascular events
Below is advice which is listed regarding the timing of elective procedures around cardiovascular events.
- Complications of ischaemic heart disease
- Recent cardioversion
- Recent stroke
If a patient attends POAC and falls within a period, as outlined below, in which it is recommended that their procedure does not go ahead, liaise with the consultant anaesthesiologist on duty.
Complications of Ischaemic Heart Disease
Care must be taken to time surgery optimally in the case of a previous myocardial infarction (MI) and stent placement. The risk of re-infarction and subsequent increased mortality is significantly raised, especially during the first 3 months post MI1.
The following recommendations are based on the 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery2.
- Elective non-cardiac surgery should be delayed 14 days after balloon angioplasty.
- Elective noncardiac surgery should optimally be delayed 365 days after drug-eluting stent (DES) implantation. If the patient had DESs placed less than one year previously, the cardiologist responsible for their care should be consulted.
- Elective noncardiac surgery after DES implantation may be considered after 180 days if the risk of further delay is greater than the expected risks of ischemia and stent thrombosis.
- Elective noncardiac surgery should not be performed within 30 days after Bare Metal Stent (BMS) implantation.
- Elective noncardiac surgery should not be performed within 14 days of balloon angioplasty.
Recent cardioversion
After receiving cardioversion, patients should undergo 21 days of uninterruopted anticoagulation. If a planned elective procedure is scheduled for within this window of time, it is recommended that it is deferred until anticoagulation can be safely interrupted.
Recent stroke
Following a stroke, cerebral autoregulation is impaired and cerebral perfusion is therefore very sensitive to even modest changes in blood pressure3. The duration of this failure of autoregulation is uncertain but it has been postulated that it may last 1–3 months4.
Following a stroke, a sufficient time period should be allowed before elective surgery for the patient’s neurological and haemodynamic status to stabilise and cerebral autoregulation to be restored to minimise the risk of a further stroke or worsening of the initial stroke.
In patients who have had a recent stroke or TIA, current evidence suggests that elective surgery shoukd be delayed for at least 3 months5.