BoardsBridgeSevere HFrEF (LVEF <30%) — Perioperative Anesthetic Management
Risk-stratify, continue GDMT, preserve sinus rhythm/preload/afterload, and prepare for mechanical circulatory support.
Severe HFrEF (LVEF <30%) roughly doubles 90-day noncardiac-surgery mortality (adjusted OR 2.35 vs no HF). Continue GDMT, maintain MAP ≥65, avoid negative inotropes, preserve sinus rhythm and preload, and stage a tMCS escalation plan before induction.
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HEADLINE: Severe HFrEF = LVEF <30% → ~8% 90-day mortality; continue GDMT, keep MAP ≥65, avoid negative inotropes, stage tMCS.
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Key numbers
- LVEF <30% → 8.34% 90-day mortality (adjusted OR 2.35 vs no HF); LVEF 30-39% → 6.58% (OR 1.85).
- BP target: MAP ≥60-65 mmHg or SBP ≥90 mmHg intraoperatively.
- IABP weaning: 1:1 → 1:2 → 1:3 (or 1:4/1:8 by manufacturer) before removal.
- Impella 2.5/CP/5.5 weaning: P1→P2 every 5 min rapid or every 2-4 h standard; P2 before decannulation.
- VA-ECMO weaning: flows reduced 0.5-1 L/min per step toward a target of 1.5-2.0 L/min.
- AKI Stage 1: Cr ↑ ≥0.3 mg/dL within 48 h or 1.5-1.9× baseline within 7 d.
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: AHA ACC Perioperative Cardiovascular 2024 · AHA ACC Perioperative Cardiovascular 2024 · AHA ACC Perioperative Cardiovascular 2024 · AHA ACC Perioperative Cardiovascular 2024
Re-review cadence: 12 months from reviewed date.
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Card ID: hfref-severe · Path: aba.cardiac.heart-failure-cardiomyopathy.hfref-severe