[Extracardiac risk factors in heart surgery--significance of anesthesia]

Concerning perioperative risk, the choice of anaesthetic is of minor importance in cardiac surgery, whereas concomitant diseases of other organ systems and kind and degree of the cardiac disease can negatively influence the risk. The risk can be reduced by adequate preoperative diagnosis and pharmacotherapy, as well as by perioperative continuation of antianginal and antihypertensive drug treatment. The qualification of the anaesthetist and optimal cooperation between surgeon and anaesthetist are essential for the perioperative patient's management. Careful preoperative medical evaluation and adequate monitoring during operation and postoperative period are further cornerstones to improve outcome as far as the anaesthesiologist's duties are concerned. Old age itself does not enhance the risk, but operative mortality is enhanced in this group due to a higher frequency of multimorbidity and emergency operations, and to more advanced symptoms of heart disease in these patients. The long-term survival of geriatric patients, however, differs not substantially from the expected survivals in this age group, and their quality of life becomes improved to the same extent as in younger patients.