Kertai MD, Bountioukos M, Boersma E, et al: Aortic stenosis: An underestimated risk factor for perioperative complications in patients undergoing noncardiac surgery. Am J Med 2004;116(1):8-13.
Goldman L: Aortic stenosis in noncardiac surgery: Underappreciated in more ways than one? (editorial) Am J Med 2004;116(1):60-1.
Aortic stenosis occurs in 2% to 9% of adults older than 65 years of age. The authors studied 108 patients with moderate (mean gradient 25 to 49 mm Hg) or severe (mean gradient >50 mm Hg) aortic stenosis, and 216 control patients who underwent noncardiac surgery at a hospital in the Netherlands. Compared with control patients, whom authors matched by calendar year and type of surgery, patients with aortic stenosis had a higher rate of death and myocardial infarction (MI) (14% vs 2%, P <.001). The severity of aortic stenosis also predicted perioperative complications, with 31% in patients with severe aortic stenosis compared to 11% in patients with moderate aortic stenosis (P = .04). Even after adjusting for higher coexisting cardiac risk factors, patients with aortic stenosis had a fivefold increase in the risk of peri-operative death and nonfatal MI (odds ratio = 5.2, 95% CI 1.6 to 17).
During preoperative consultation, clinicians should be diligent in listening to the heart and should carefully assess any patients with systolic murmurs. Patients with possible important aortic stenosis, especially those with symptoms (heart failure, possible angina, syncope, or presyncope) must undergo echocardiography. In symptomatic patients with aortic stenosis, valve replacement should be considered before surgery.