TY - JOUR
T1 - Cardiac Risk in Patients Aged >75 Years With Asymptomatic, Severe Aortic Stenosis Undergoing Noncardiac Surgery
AU - Calleja, Anna M.
AU - Dommaraju, Subha
AU - Gaddam, Rakesh
AU - Cha, Stephen
AU - Khandheria, Bijoy K.
AU - Chaliki, Hari P.
N1 - Funding Information:
This study was funded in part by the A. J. and Sigismunda Palumbo Charitable Trust .
PY - 2010/4/15
Y1 - 2010/4/15
N2 - Severe aortic stenosis (AS) is a known predictor of cardiac risk during noncardiac surgery. However, for patients with asymptomatic AS, it is unclear whether aortic valve surgery should precede noncardiac surgery. We studied 30 patients with asymptomatic, severe AS with a mean age of 78 ± 9 years, an aortic valve area of 0.77 ± 0.16 cm2, a mean gradient of 50.1 ± 9.5 mm Hg, and a peak gradient of 84 ± 22 mm Hg. They were compared to 60 age-matched (within 2 years) and gender-matched (ratio of 1:2) patients with mild-to-moderate AS (controls). The primary end point of the study was a composite of death, myocardial infarction, heart failure, ventricular arrhythmias before dismissal, and intraoperative hypotension requiring vasopressor administration. Most patients (>75%) and controls underwent intermediate-risk surgical procedures that were similar with respect to the nature of the surgery, type of anesthesia used, and preoperative risk assessment. Combined postoperative events were more common for the patients (n = 10; 33%) than for the controls (n = 14; 23%), but the difference was not statistically significant (p = 0.06). Intraoperative hypotension requiring vasopressor use was more likely for the patients (n = 9; 30%) than for the controls (n = 10; 17%; odds ratio 2.5; p = 0.11). The perioperative myocardial infarction rates were similar for both groups (3%; p = 0.74). No deaths, heart failure events, or ventricular arrhythmias occurred in the patients and 1 death and 1 ventricular arrhythmia episode occurred in the controls. In conclusion, intermediate-to-low-risk noncardiac surgery for patients with severe, asymptomatic AS can be performed relatively safely. Intraoperative hypotension was frequent and required prompt and aggressive treatment.
AB - Severe aortic stenosis (AS) is a known predictor of cardiac risk during noncardiac surgery. However, for patients with asymptomatic AS, it is unclear whether aortic valve surgery should precede noncardiac surgery. We studied 30 patients with asymptomatic, severe AS with a mean age of 78 ± 9 years, an aortic valve area of 0.77 ± 0.16 cm2, a mean gradient of 50.1 ± 9.5 mm Hg, and a peak gradient of 84 ± 22 mm Hg. They were compared to 60 age-matched (within 2 years) and gender-matched (ratio of 1:2) patients with mild-to-moderate AS (controls). The primary end point of the study was a composite of death, myocardial infarction, heart failure, ventricular arrhythmias before dismissal, and intraoperative hypotension requiring vasopressor administration. Most patients (>75%) and controls underwent intermediate-risk surgical procedures that were similar with respect to the nature of the surgery, type of anesthesia used, and preoperative risk assessment. Combined postoperative events were more common for the patients (n = 10; 33%) than for the controls (n = 14; 23%), but the difference was not statistically significant (p = 0.06). Intraoperative hypotension requiring vasopressor use was more likely for the patients (n = 9; 30%) than for the controls (n = 10; 17%; odds ratio 2.5; p = 0.11). The perioperative myocardial infarction rates were similar for both groups (3%; p = 0.74). No deaths, heart failure events, or ventricular arrhythmias occurred in the patients and 1 death and 1 ventricular arrhythmia episode occurred in the controls. In conclusion, intermediate-to-low-risk noncardiac surgery for patients with severe, asymptomatic AS can be performed relatively safely. Intraoperative hypotension was frequent and required prompt and aggressive treatment.
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U2 - 10.1016/j.amjcard.2009.12.019
DO - 10.1016/j.amjcard.2009.12.019
M3 - Article
C2 - 20381670
AN - SCOPUS:77950458080
SN - 0002-9149
VL - 105
SP - 1159
EP - 1163
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 8
ER -