Optimization of cardiac performance in chronic heart failure patients undergoing elective non-cardiac surgery

Chronic heart failure (HF) patients are submitted to non-cardiac surgery with an increased frequency owing to the advanced age of this group. Peri-operative adverse cardiac outcomes ensue as a result of preexisting cardiac disease which is aggravated by the anaesthetic manipulations and the surgical stress. The goal is to optimize preoperatively this fragile group of patients based on the contemporary guidelines for the management of patients with cardiac insufficiency. Pharmacological balancing remains the cornerstone for optimal results, although other modalities, invasive or not, contribute to improved outcome. The absence of strict guidelines for the preoperative management of these patients underlines the complexity and heterogeneity of the problem. Either way, chronic HF patients undergoing non-cardiac surgery constitute a difficult subset, and most probably an individualized approach will reduce postoperative cardiac complications and mortality.