Perioperative assessment and management of patients with valvular heart disease undergoing noncardiac surgery.

Valvular heart disease in a variety of forms is not uncommon, especially among older patients undergoing noncardiac surgery, and can be associated with increased perioperative cardiac risk. Patients with aortic stenosis are at greatest risk, although other valve lesions also can pose the risk of increased perioperative morbidity. During preoperative evaluation, attention to the presence, nature and severity of valvular heart disease allows appropriate perioperative monitoring and therapy with a goal to minimize the risk of perioperative cardiac morbidity and mortality associated with noncardiac surgery. Appropriate antibiotic prophylaxis reduces the risk of infective endocarditis. Finally, some patients with valvular heart disease and all patients with a mechanical valve prosthesis require long-term anticoagulation, which must be managed during the perioperative period.