Cardiovascular considerations before elective noncardiac surgery in COVID-19 patients

Editor's Note

In this viewpoint, researchers from Stanford University School of Medicine, note that it is unclear whether cardiovascular complications associated with COVID-19 persist beyond the acute phase of illness and whether a history of COVID-19 warrants any additional preoperative cardiac assessments before having elective surgery.

They review the literature and conclude that:

• Standard clinical practice guidelines for preoperative cardiac risk assessments can be applied to most COVID-19 patients having noncardiac surgery.
• The severity of COVID-19 should be considered in addition to traditional cardiac risks.
• Elective surgery should be deferred 7 weeks or more after a COVID-19 diagnosis to reduce postoperative mortality, but the optimal timing of surgery is unknown.
• Additional preoperative cardiovascular testing may be considered in selected patients.

Ultimately, the researchers say, prospective trials evaluating the optimal approach to preoperative cardiovascular risk stratification for patients with a history of COVID-19 are necessary.