Appropriate Perioperative Therapy in Patients with Chronic Heart Failure Undergoing Surgery

In recent years, the number of patients with chronic heart failure (CHF) is constantly increasing. CHF is a disease of the geriatric population and creates an enormous burden on the health system. Overall, the prognosis of the disease is worse, resulting in high mortality after diagnosis. The optimal treatment of CHF patients is based on a combination of medication and requires frequent adaptation. Also, in the perioperative period, both surgeons and anesthesiologists are more frequently involved in the care of CHF patients in the acute and elective settings. Therefore, knowledge about the disease, risk factors, and optimization of treatment is needed. In particular, the effects of anesthesia and surgery on the hemodynamic situation of this patient population require our attention. In this chapter, we will discuss the pathophysiology, prediction of severity, and treatment of perioperative therapy in CHF patients. Special attendance is directed toward preoperative risk assessment and the interdisciplinary approach for decision-making in the surgical pathway. Moreover, we will share new insights in the treatment of hemodynamic instability and perioperative monitoring in heart failure patients and summarize the actual knowledge in this area.