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2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management

Topics: The Cardiac Consult



01/08/2014 00:00:00

Current versions available to download

Publication dateVersionsReferencesSize
2014Full TextESC/ESA Non-Cardiac Surgery Guidelines - Eur Heart J (2014) 35 , 2383–243
2014Pocket GuidelinesPocket Guidelines Abriged version
2014PdaPocket Guidelins Mobile App
2014 Slide-set2014 Slides on NCS4 MB
2014CME Questions36 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

Declarations of Interest of the experts involved in the elaboration of the document

Endorsed by:

Table of contents

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

Previous versions

 2009 Pre-operative Cardiac Risk Assessment & Perioperative  Cardiac Management in Non-Cardiac Surgery
Eur Heart J 30, 2769–2812; doi:10.1093/eurheartj/ehp337
Eur Heart J doi:10.1093/eurheartj/ehp606

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