4
Diagnosis
Table 2. Supplemental Preoperative Evaluation (cont'd)
Recommendations COR LOE
Cardiopulmonary exercise testing
Cardiopulmonary exercise testing may be considered for
patients undergoing elevated risk procedures in whom
functional capacity is unknown.
IIb B
Noninvasive pharmacological stress testing before noncardiac surgery
It is reasonable for patients who are at elevated risk
for noncardiac surgery and have poor functional
capacity (<4 METs) to undergo either DSE or MPI
noninvasive pharmacological stress testing (either DSE or
pharmacological stress MPI) if it will change management.
IIa B
Routine screening with noninvasive stress testing is NOT
useful for patients undergoing low-risk noncardiac surgery.
III: No
Benefit
B
Preoperative coronary angiography
Routine preoperative coronary angiography is NOT
recommended.
III: No
Benefit
C
Table 3. Valvular Heart Disease, CIEDs and Pulmonary
Vascular Disease
Recommendations COR LOE
Valvular Heart Disease
It is recommended that patients with clinically suspected
moderate or greater degrees of valvular stenosis or
regurgitation undergo preoperative echocardiography if
there has been either 1) no prior echocardiography within
1 year or 2) a significant change in clinical status or physical
examination since last evaluation.
I C
For adults who meet standard indications for valvular
intervention (replacement and repair) on the basis of
symptoms and severity of stenosis or regurgitation, valvular
intervention before elective noncardiac surgery is effective
in reducing perioperative risk.
I C
Aortic Stenosis
Elevated-risk elective noncardiac surgery with appropriate
intraoperative and postoperative hemodynamic monitoring
is reasonable to perform in patients with asymptomatic
severe aortic stenosis.
IIa B
Mitral Stenosis
Elevated-risk elective noncardiac surgery using appropriate
intraoperative and postoperative hemodynamic monitoring
may be reasonable in asymptomatic patients with severe
mitral stenosis if valve morpholog y is not favorable for
percutaneous mitral balloon commissurotomy.
IIb C
