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Recommendation Table 32 — Recommendations for management of patients with diabetes mellitus undergoing non-cardiac surgery ........................................................................................ 3889 Recommendation Table 33 — Recommendations for peri-operative monitoring and anaesthesia ......................................... 3893 Recommendation Table 34 — Recommendations for peri-operative cardiovascular complications ....................................... 3899

List of tables

Table 1 Classes of recommendations .................................................... 3833 Table 2 Levels of evidence .......................................................................... 3833 Table 3 New concepts and sections in the current guidelines ... 3834 Table 4 What is new ..................................................................................... 3834 Table 4A New recommendations ........................................................... 3834 Table 4B Revised recommendations ...................................................... 3838 Table 5 Surgical risk estimate according to type of surgery or intervention ....................................................................................................... 3842 Table 6 Risk score calculators ................................................................... 3848 Table 7 Pharmacokinetic and pharmacodynamic characteristics of antiplatelets ........................................................................................................ 3857 Table 8 Pharmacokinetic and pharmacodynamic characteristics of oral anticoagulants .......................................................................................... 3858 Table 9 Bleeding risk according to type of non-cardiac surgery 3858 Table 10 Laboratory parameters for the diagnosis of absolute iron-deficiency anaemia ................................................................................ 3870 Table 11 Peri-operative approach to patients with ventricular assist devices undergoing non-cardiac surgery ................................... 3875 Table 12 Peri-operative management of patients with arrhythmias 3880 Table 13 Risk stratification for non-cardiac surgery in adults with congenital heart disease ............................................................................... 3883 Table 14 Patient-related and surgery-related factors to be considered when assessing peri-operative risk in patients with pulmonary arterial hypertension .............................................................. 3885 Table 15 Factors that could influence peri-operative risk during cancer surgery and preventive strategies ............................................. 3890

List of figures

Figure 1 Total risk is an interaction of patient-related and surgery-related risk ........................................................................................ 3841 Figure 2 Pre-operative assessment before non-cardiac surgery 3844 Figure 3 Examples of questions and concerns expressed by patients ................................................................................................................ 3847 Figure 4 Recommended measurements to assess and detect the risk of post-operative cardiac complications ...................................... 3850 Figure 5 Recommendations for management of antiplatelet therapy in patients undergoing non-cardiac surgery ....................... 3859 Figure 6 P2Y12 inhibitor interruption after percutaneous coronary intervention before elective non-cardiac surgery ......... 3860 Figure 7 Bridging with intravenous antiplatelet agents. ASA, acetylsalicylic acid; FU, follow-up; LD, loading dose; NCS, non-cardiac surgery; o.d., once a day ...................................................... 3861 Figure 8 Recommendations for management of oral anticoagulation therapy in patients undergoing non-cardiac surgery ................................................................................................................. 3863 Figure 9 Peri-operative management of non-vitamin K antagonist oral anticoagulant according to the periprocedural risk of bleeding 3865 Figure 10 Timing of last non-vitamin K antagonist oral anticoagulant dose before elective NCS according to renal function ...................... 3866 Figure 11 Suggested strategy for potential reversal of non-vitamin K oral anticoagulants effect ........................................................................ 3867 Figure 12 Management of patients with acute or chronic coronary syndrome scheduled for non-cardiac surgery .................................... 3873 Figure 13 Management of patients with severe aortic valve stenosis scheduled for non-cardiac surgery ........................................ 3876 Figure 14 Management of patients with secondary mitral valve regurgitation scheduled for non-cardiac surgery .............................. 3877 Figure 15 Optimal location of return electrode during unipolar electrosurgery in patients with cardiac implantable electronic devices, depending on the surgery site .................................................. 3882 Figure 16 Pathophysiological approach to address intra-operative hypotension ....................................................................................................... 3892 Figure 17 Factors associated with peri-operative cardiovascular complications. SNS, sympathetic nervous system ............................ 3894 Figure 18 Differential diagnosis of elevated post-operative cardiac troponin concentrations .............................................................................. 3895 Figure 19 Systematic work-up (aetiology) and therapy of peri-operative myocardial infarction/injury .......................................... 3896 Figure 20 Prevention and management of post-operative atrial fibrillation ............................................................................................................ 3898 Figure 21 Central illustration: the complex interplay between the intrinsic risk of surgery and the patient risk of peri-operative cardiovascular complications ..................................................................... 3906

Abbreviations and acronyms

AAA Abdominal aortic aneurysm AAD Antiarrhythmic drug ACEI Angiotensin-converting-enzyme inhibitor ACHD Adults with congenital heart disease ACS Acute coronary syndrome ACS NSQIP American College of Surgery National Surgical Quality Improvement Program AF Atrial fibrillation AKI Acute kidney injury aPTT Activated partial thromboplastin time AR Aortic valve regurgitation ARB Angiotensin receptor blocker ARNI Angiotensin receptor neprilysin inhibitor AS Aortic valve stenosis ASA Acetylsalicylic acid ASA–PS American Society of Anesthesiology Physical Status ASCVD Atherosclerotic cardiovascular disease AUB-HAS2 American University of Beirut (AUB)-HAS2 AUC Area under curve AVR Aortic valve replacement BAV Balloon aortic valvuloplasty BCSH British Committee for Standards in Haematology b.i.d. Bis in die (twice a day) BTKi Bruton tyrosine kinase inhibitors BMI Body mass index Downloaded from academic.oup.com/eurheartj/article/43/39/3826/6675076 by guest on 07 October 2026