In industrialized nations, chronic heart failure ranks as a leading reason for both hospital admissions and mortality. It affects about 1–2% of the population in Western countries, with its prevalence escalating with advancing age. While individuals younger than 55 years exhibit an incidence of less than 1%, this figure surges to around 10% among those aged 70 and above.
Diastolic dysfunction is emerging as an increasingly significant concern in the perioperative setting. There's a noticeable shift in heart failure patterns, with the incidence of systolic heart failure decreasing and diastolic heart failure becoming more prevalent, attributed to the rise in underlying causative factors. Notably, HFpEF now accounts for approximately half of all new heart failure cases in the United States, with its proportion steadily increasing, particularly among men. This trend suggests a greater perioperative challenge for anesthesiologists due to the morbidity associated with managing HFpEF in surgical settings.
In the surgical domain, the severity of HFpEF serves as an indicator of early mortality risks and the recurrence of mitral regurgitation post-mitral valve surgery. Proactive operative interventions in cases of mitral regurgitation can forestall myocardial dysfunction. It's also observed that LV diastolic function typically deteriorates immediately following coronary-artery bypass grafting (CABG) surgery but generally reverts to preoperative levels within six months. Severe HFpEF is associated with respiratory complications and extended hospital stays in off-pump CABG surgeries, alongside an increase in perioperative adverse events and heart failure exacerbations across various surgical procedures, including vascular and lung transplant surgeries. Given these findings, a deep understanding of DD's impact on perioperative mortality across cardiac, vascular, and transplant surgeries is essential for anesthesiologists engaged in perioperative care.
