Patients undergoing cardiac surgery pose numerous perioperative challenges. They tend to be older with compromised cardiovascular reserve and multiple comorbidities. As they run a high risk for major adverse cardiac events (MACE) it is essential, in planning their perioperative journey, to conduct a thorough preoperative assessment. The Enhanced Recovery after Surgery (ERAS) Cardiac Society has published recommendations for this cohort of patients.1 Advances in perioperative planning and pre-habilitation in cardiac surgery advocate joint decision-making between patients and inter-professional teams. Such practice secures individualized risk assessments and perioperative care pathways. This article illustrates the history, examination and investigations required in adult cardiac surgical patients, and provides information on perioperative planning and prehabilitation.

The aims of preoperative anaesthetic assessment are to:

assess the medical status of the patient

assess the risks posed by the proposed surgery

identify patients at high risk of MACE

identify patients requiring further investigation prior to surgery

recommend strategies to mitigate risks specific to each patient.