Preoperative investigations in adult cardiac surgery patients

Preoperative investigations in cardiac surgery can be divided into diagnostic and assessment of fitness for surgery. Diagnostic investigations are used to detect and evaluate coronary, valvular, myocardial and thoracic aortic disease. Knowledge of an individual patient's co-morbidities is essential in determining the risk of postoperative morbidity and mortality, thus allowing for more accurate informed consent. Furthermore, the results of preoperative investigations may predict the likely postoperative hospital stay and support required in order to maximize the chances of uneventful recovery. Additionally, the changing operative demographic, with an increased age and burden of co-morbidities frequently makes open-heart surgery challenging prompting a reliance on minimally invasive procedures that may not require cardiopulmonary bypass such as transcatheter aortic valve implantation (TAVI) and mitral valve repair. This article highlights the tests for preoperative diagnosis and assessment of fitness for surgery in adult cardiac patients. They should be used to guide clinicians in making appropriate management decisions, particularly with regard to elderly, frail or complex cardiac cases discussed in the setting of joint cardiology and cardiothoracic meetings.