Impact of Aortic Stenosis on Postoperative Outcomes After Noncardiac Surgeries

Agarwal, Shikhar; Rajamanickam, Anitha; Bajaj, Navkaranbir; Catacutan, Thadeo; Griffin, Brian P.; Svensson, Lars G.; Anabtawi, Abdel; Tuzcu, E. Murat; Kapadia, Samir

doi:10.1378/chest.1388885

Cited by 21 publications

(38 citation statements)

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“…2 Using data from the Cleveland Clinic, Agarwal et al observed higher event rates (defined as mortality or myocardial infarction) in AS patients compared with matched controls undergoing elective noncardiac surgery (5.7% vs 2.7%, P = 0.02). 21 Suggesting relatively good outcomes, a very recent study by Tashiro et al of patients with severe AS (as defined by echocardiography) and matched controls reported a mortality rate of 5.9% for those with AS and 3.1% for controls (P = 0.15). 5 The surgery types were comparable to those in our study, but <10% of all surgeries were of the emergency type in the study by Tashiro et al, which likely have contributed to the much lower mortality rates.…”

Section: Discussionmentioning

confidence: 98%

Noncardiac Surgery in Patients With Aortic Stenosis: A Contemporary Study on Outcomes in a Matched Sample From the Danish Health Care System

Andersson

Jørgensen

Martinsson

et al. 2014

Clinical Cardiology

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BackgroundPast research has identified aortic stenosis (AS) as a major risk factor for adverse outcomes in noncardiac surgery; however, more contemporary studies have questioned the grave prognosis. To further our understanding of this, the risks of a 30‐day major adverse cardiovascular event (MACE) and all‐cause mortality were investigated in a contemporary Danish cohort.HypothesisAS is not an independent risk factor for adverse outcomes in noncardiac surgery.MethodsAll patients with and without diagnosed AS who underwent noncardiac surgery in 2005 to 2011 were identified through nationwide administrative registers. AS patients (n = 2823; mean age, 75.5 years, 53% female) were matched with patients without AS (n = 2823) on propensity score for AS and surgery type.ResultsIn elective surgery, MACE (ie, nonfatal myocardial infarction, ischemic stroke, or cardiovascular death) occurred in 66/1772 (3.7%) of patients with AS and 52/1772 (2.9%) of controls (P = 0.19), whereas mortality occurred in 67/1772 (3.8%) AS patients and 51/1772 (2.9%) controls (P = 0.13). In emergency surgery, 163/1051 (15.5%) AS patients and 120/1051 (11.4%) controls had a MACE (P = 0.006), whereas 225/1051 (21.4%) vs 179/1051 (17.0%) AS patients and controls died, respectively (P = 0.01). Event rates were higher for those with symptoms (defined as use of nitrates, congestive heart failure, or use of loop diuretics), compared with those without symptoms (P < 0.0001).ConclusionsAS is associated with high perioperative rates of MACE and mortality, but perhaps prognosis is, in practice, not much worse for patients with AS than for matched controls. Symptomatic patients and patients undergoing emergency surgery are at considerable risks of a MACE and mortality.

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Section: Discussionmentioning

confidence: 98%

Noncardiac Surgery in Patients With Aortic Stenosis: A Contemporary Study on Outcomes in a Matched Sample From the Danish Health Care System

Andersson

Jørgensen

Martinsson

et al. 2014

Clinical Cardiology

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“…However these recommendations are based on few, non recent, small observational studies. In patients with severe aortic stenosis who refuse cardiac surgery or are otherwise not candidates for aortic valve replacement, was reported a mortality risk associated with non-cardiac surgery close to 10% [4,8] . The optimal management of asymptomatic patients with severe AS is even more controversial, with few available data to determine the best clinical approach.…”

Section: Guidelinesmentioning

confidence: 99%

“…In a recent paper Agarwal et al [4] studied the outcome in patients with aortic stenosis undergoing non-cardiac surgery compared to a matched control group. AS was classified moderate (valve area: 1.0-1.5 cm 2 ) or severe (valve area: < 1.0 cm 2 ).…”

Section: Elective Surgerymentioning

confidence: 99%

“…Not uncommonly however patients with untreated aortic stenosis undergo non-cardiac surgery. The main cause of non adherence to guidelines are asymptomatic cardiac status, patient refusal to valve replacement, urgency-emergency of non-cardiac surgery and finally prohibitive risk arising from the cardiac surgery related to multiple patient comorbidities [4] . In patients with known aortic valve disease, since disease progression is highly variable, a careful clinical and echocardiographic evaluation must be obtained closely to surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

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Aortic Stenosis and Non-Cardiac Surgery

Rostagno

2016

Journal of Cardiology and Therapy

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Advances in surgical and anesthetic techniques associated with closer perioperative monitoring appear to allow non-cardiac elective surgical procedures possible with acceptable risk in patients with severe aortic stenosis. A correct diagnosis of the severity of aortic stenosis is mandatory in preoperative evaluation of these patients. Recent published data suggest that at least for "asymptomatic severe aortic stenosis" patients with preserved LV systolic function and no other significant valvular pathology, a reappraisal of the grading of the severity of AS in general and reassessment of perioperative risk during elective non-cardiac surgery is needed.

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“…myocardial infarction) during non-cardiac surgery in AS. 12,13 Indeed, the onset of symptoms in the individual patient with AS also depends on the severity of the aortic obstruction, as well as on left ventricular (LV) function/remodelling, and the status of the peripheral circulation. When peripheral demands exceed the cardiac output, symptoms can occur ( Figure 1).…”

mentioning

confidence: 99%