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ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management

ESC Clinical Practice Guidelines

The Cardiac Consult
Guidelines version available to download
Published in 2014
Reference ESC/ESA Non-Cardiac Surgery Guidelines - Eur Heart J (2014) 35 , 2383–243
Published in 2014
Reference Pocket Guidelines Abriged version
  • PDA
  • Published in 2014
    Reference Pocket Guidelins Mobile App
    Published in 2014
    Reference 2014 Slides on NCS
    Published in 2014
    Reference 36 CME Questions - Non-Cardiac Surgery

    Steen Dalby Kristensen (Chairperson) , Juhani Knuuti (Chairperson), Antti Saraste, Stefan Anker, Hans Erik Bøtker, Stefan De Hert, Ian Ford, Jose Ramo´n Gonzalez-Juanatey, Bulent Gorenek, Guy Robert Heyndrickx, Andreas Hoeft, Kurt Huber, Bernard Iung, Keld Per Kjeldsen, Dan Longrois, Thomas F. Lu¨ scher, Luc Pierard, Stuart Pocock, Susanna Price, Marco Roffi, Per Anton Sirnes, Miguel Sousa-Uva, Vasilis Voudris, Christian Funck-Brentano

    Table of contents: Full Text (ESC Clinical Practice Guidelines)

    Preamble and introduction

    • The magnitude of the problem
    • Change in demographics
    • Purpose and organization

    Pre-operative evaluation

    • Surgical risk for cardiac events
    • Type of surgery
      • Endovascular vs. open vascular procedures
      • Open vs. laparoscopic or thoracoscopic procedures
    • Functional capacity
    • Risk indices
    • Biomarkers
    • Non-invasive testing
      • Non-invasive testing of cardiac disease
      • Non-invasive testing of ischaemic heart disease
    • Invasive coronary angiography

    Risk-reduction strategies

    • Pharmacological
      • Beta-blockers
      • Statins 
      • Nitrates
      • angiotensin -converting enzyme inhibitors and angiotensin-receptor blockers 
      • Calcium channel blockers 
      • Alpha2 receptor agonists 
      • Diuretics
    • Peri-operative management in patients on anti-platelet agents
      • Aspirin
      • Dual anti-platelet therapy 
      • Reversal of anti-platelet therapy
    • Peri-operative management in patients on anticoagulants
      • Vitamin K antagonists
      • Non-vitamin K antagonist oral anticoagulants
      • Reversal of anticoagulant therapy
    • Revascularization
      • Prophylactic revascularization in patients with asymptomatic or stable ischaemic heart disease
      • Type of prophylactic revascularization in patients with stable ischaemic heart disease 
      • Revascularization in patients with non-ST-elevation acute coronary syndrome

    Specific diseases

    • Chronic heart failure
    • Arterial hypertension
    • Valvular heart disease
      • Patient evaluation 
      • Aortic stenosis 
      • Mitral stenosis
      • Primary aortic regurgitation and mitral regurgitation 
      • Secondary mitral regurgitation 
      • Patients with prosthetic valve(s) 
      • Prophylaxis of infective endocarditis
    • Arrhythmias
      • New-onset ventricular arrhythmias in the pre-operative period 
      • Management of supraventricular arrhythmias and atrial fibrillation in the pre-operative period.
      • Peri-operative bradyarrhythmias 
      • Peri-operative management of patients with pacemaker/implantable cardioverter defibrillator 
    • Renal disease
    • Cerebrovascular disease 
    • Peripheral artery disease 
    • Pulmonary disease 
    • Congenital heart disease

    Peri-operative monitoring

    • Electrocardiography
    • Transoesophageal echocardiography 
    • Right heart catheterization
    • Disturbed glucose metabolism 
    • Anaemia


    • Intra-operative anaesthetic management
    • Neuraxial techniques 
    • Peri-operative goal-directed therapy 
    • Risk stratification after surgery 
    • Early diagnosis of post-operative complications 
    • Post-operative pain management

    Gaps in evidence




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    European Society
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