Cardiology>>>>>Assessment for Surgery
Question 24#

A patient has been referred for CABG. He is concerned about complications and wants to know the risk of perioperative stroke. 

What is the typical nationally reported risk?

A. There is no risk since the aortic valve is not being replaced
B. 1%
C. 5%
D. 10%
E. If an off-pump procedure is performed, the risk can be as high as 7%

Correct Answer is B

Comment:

Although the absolute risks will vary from unit to unit and from patient to patient, it is useful to know the typical risks of cardiac surgery. The Sixth National Adult Cardiac Surgical Database Report gives a typical risk of 1% for isolated CABG. An aortic valve replacement increases this risk to closer to 2%. Off-pump CABG avoids cardiopulmonary bypass and there is some evidence demonstrating a reduced risk of stroke, although since the patients selected for off-pump CABG differ in their risks, it is difficult to apply this to the whole population. Poldermans et al. ESC guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. EHJ 2009; 30: 2769–2812.

Boersma E, Kertai MD, Schouten O, et al. Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med 2005; 118: 1134–41.

Biccard BM. Relationship between the inability to climb two flights of stairs and outcome after major non-cardiac surgery: implications for the pre-operative assessment of functional capacity. Anaesthesia 2005; 60: 588–93.

Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100: 1043–9. Vahanian et al. ESC guidelines for the management of valvular heart disease (version 2012). EHJ 2012; 33: 2451–96.

Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 2007; 116: 1971–96.