Preoperative pulmonary optimization and risk mitigation

Abstract

Optimization of pulmonary health and risk mitigation is a critical component of preoperative preparation for cardiac surgery, impacting both short- and long-term postoperative outcomes. A wide array of tests and interventions have been studied such as pulmonary function testing, pulmonary risk stratification, and prehabilitation therapies. While each intervention has its utility, there lacks consensus on pulmonary evaluation and optimization prior to cardiac surgery. Special consideration should be given to the preoperative management and treatment of underlying comorbid pulmonary conditions that frequently impact postoperative outcomes. Targeted approaches have demonstrated potential to mitigate the risks associated with these conditions and improve surgical outcomes. This review aims to summarize recommended preoperative pulmonary evaluation and prehabilitation protocols, and discuss targeted approaches for patient-specific comorbidities to optimize patients and reduce postoperative complications in cardiac surgery.