Modern strategies for anesthetic and perioperative management in cardiac surgery patients with acute heart failure

Background. Patients with acute heart failure (AHF) and cardiogenic shock requiring cardiac surgery represent the cohort of the highest risk with extremely poor perioperative outcomes. Standard risk stratification tools (EuroSCORE II, STS scores) consistently underestimate mortality in this population, necessitating integration of additional prognostic modalities including biomarkers and dynamic hemodynamic assessment. Objective. To analyze current evidence on optimizing perioperative management of patients with AHF and cardiogenic shock. Material and methods. A systematic review was performed across PubMed, Embase, Cochrane Library, and Google Scholar databases (2000—2025). Systematic reviews, meta-analyses, randomized controlled trials, and large cohort studies addressing perioperative management of adults with AHF or cardiogenic shock undergoing cardiac surgery were included. Among 410 initially identified records, 35 studies met inclusion criteria after screening and full-text assessment. Results. In addition to EuroSCORE II, modern approach includes assessment of biomarkers (ST2 protein, galectin-3, NT-proBNP), perfusion parameters (lactate, central venous saturation (ScvO2), and cardiogenic shock-specific assessment (SCAI). The choice of anesthesia is driven by the need for hemodynamic stability, not by a debate about support methods. Hybrid and minimally invasive procedures instead of open surgery are justified. Perfusion modification (MECC, pulsatile mode) reduces inflammatory response and improves organ perfusion. Intensive care strategy should be preemptive with early planning of mechanical circulatory support (extracorporeal membrane oxygenation) and multiple organ support. Conclusion. Perioperative management of cardiac surgery patients with acute heart failure should be based on a multidisciplinary approach including advanced risk assessment, individual choice of surgical tactics and anesthesia, modified perfusion and preventive intensive care.