In a patient with decompensated heart failure requiring urgent non-cardiac surgery, how much volume optimization do you pursue preoperatively, and at what point does the risk of further surgical delay outweigh the benefit of continued diuresis?

This is an interesting question and a challenging situation for a patient. I think that the ideal scenario would be for the patient to be euvolemic clinically prior to surgery. I am very aggressive with intravenous diuretics. I think that a discussion with the patient, with the surgeon, and with ane...

I would recommend preoperative placement of a Swan-Ganz catheter in this situation to guide perioperative management, including intensity of diuresis and use of intravenous inotropic agents and/or vasodilators.

Management of high-risk patients such as this is a reasonable part of cardiology practice. I believe and agree that RHC can be very helpful in perioperative management of these high-risk patients.