PERIOPERATIVE ANESTHETIC MANAGEMENT IN PATIENTS WITH HEART FAILURE: FROM RISK ASSESSMENT TO HEMODYNAMIC OPTIMIZATION, INTEGRATING FUNCTIONAL CAPACITY ASSESSMENT AND EXERCISE PREHABILITATION – A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5366Keywords:
HF, HFrEF, HFpEF, Perioperative Care, Hemodynamic Monitoring, Quality of CareAbstract
Background: Heart failure (HF) increases perioperative complications and mortality in patients undergoing non-cardiac surgery. Both heart failure with reduced ejection fraction and preserved ejection fraction increase cardiovascular risk and require perioperative management.
Aim: This review summarizes evidence on perioperative anesthetic management in patients with HF undergoing non-cardiac surgery, focusing on risk assessment, medical therapy optimization, intraoperative hemodynamic management, fluid therapy, postoperative monitoring and impact of exercise on recovery.
Materials and Methods: This narrative review included PubMed-indexed studies published between 2021 and 2026. ESC consensus statements, randomized trials, and large cohort studies were analyzed to summarize practical recommendations for perioperative management of HF.
Results: Preoperative evaluation should include clinical assessment, natriuretic peptide measurement, and echocardiography. Optimization of medical therapy and euvolemia is essential. During surgery, maintaining MAP ≥ 65 mmHg, careful fluid therapy, and early vasopressor use may reduce myocardial injury.
Conclusions: Perioperative management of patients with heart failure should include risk assessment, prehabilitation, hemodynamic control, multidisciplinary care, and functional capacity evaluation to improve short-term outcomes.
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Copyright (c) 2026 Paula Żak, Patrycja Pietraszkiewicz, Inez Michalska, Zuzanna Korbel, Katarzyna Pinkowska, Zuzanna Taciak, Filip Glista, Anna-Maria Grzeczka, Mikołaj Jaszowski, Agnieszka Dąbrowska, Weronika Nawrocka
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