Comments on the guidelines (2022) of the ESC on non-cardiac surgery

With increasing life-expectancy due to lifestyle and modern medical care, the number of cardiovascular patients in need of non-cardiac surgery (NCS) is also increasing. In addition to cardiovascular diseases, these patients often have comorbidities, such as diabetes mellitus, atherosclerosis, stroke, obesity, kidney disease and cancer. This significantly increases the perioperative risk during elective NCS particularly in the case of emergency NCS. Out of 300 million surgical procedures performed yearly worldwide [1], there are more than 4 million perioperative deaths. A clinical individual risk assessment is therefore essential. Especially for Germany with a high proportion of older patients, an assessment of cardiovascular morbidity and mortality in patients undergoing NCS is important. After 8 years the ESC has completed a comprehensive review process of the existing medical knowledge and clinical study data for the management of cardiovascular risk in patients undergoing NCS [2]. Recommendations have been adapted and renewed and new chapters have been added. Factors such as frailty and functional capacity are included in the recommendations. In clinical practice cardiovascular biomarkers should be used in both preoperative risk stratification and to identify perioperative complications. Depending on the bleeding risk of the planned NCS, antithrombotic therapy with platelet aggregation inhibitors or oral anticoagulation is also increasingly individualized in line with the new guidelines for acute and chronic coronary syndromes. A standardized scheme for high-sensitivity cardiac troponin determination should enable early detection of perioperative or postoperative myocardial infarction in patients at risk. The new guidelines recommend interdisciplinary team decision making for perioperative care for high-risk patients with severe coronary heart disease, valve defects or wearers of ventricular support systems.