Introduction

Adult cardiac surgical patients present for surgical intervention with varying acuity, from the elective clinic patient with no or minimal symptoms, to the emergent patient in extremis from a life-threatening cardiovascular condition. Although the time available to the cardiothoracic surgeon for preoperative evaluation and optimization varies based on the patient scenario, the following overarching objectives of preoperative evaluation are consistent:

1. Ascertain or confirm the primary cardiac diagnosis.
2. Identify comorbid conditions.
3. Review prior testing and obtain additional indicated testing when feasible.
4. Assess perioperative risk for mortality and other complications, facilitating informed consent with the patient and family regarding expectations and prognosis.

There may be ample time to safely accomplish the above objectives, or time may be very limited. Nevertheless, each patient should undergo a systematic preoperative evaluation with the above 4 objectives in mind.