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Am Fam Physician. 2004;70(9):1794-1796

Aortic stenosis, one of the most common valvular heart diseases in patients 65 years and older, occurs in approximately 2 to 9 percent of persons in this age group and may be a risk factor for perioperative cardiac complications in noncardiac surgery. Results from recent studies have been inconsistent as to whether aortic stenosis increases perioperative cardiac complications after surgery. In one recent study, increased peak aortic gradients were found to be associated with increased cardiovascular morbidity. Kertai and associates evaluated perioperative mortality and nonfatal myocardial infarction (MI) over time in patients with moderate to severe aortic stenosis who were undergoing noncardiac surgery.

The study was a retrospective examination of charts from patients who underwent noncardiac surgery between January 1991 and December 2000 at one medical center. All patients with moderate (mean gradient of 25 to 49 mm Hg) and severe (mean gradient of at least 50 mm Hg) aortic stenosis were included in the study. Patients without aortic stenosis undergoing noncardiac surgery during the study period were selected as control patients. Mortality and nonfatal MIs were recorded if they occurred before discharge from the hospital or within 30 days after the procedure. Data collected included clinical risk factors, type of surgery, and perioperative management.

There were 108 patients who met the criteria for moderate or severe aortic stenosis during the period. These patients were compared with 216 control patients. Patients with aortic stenosis were significantly more likely than control patients to die or have an acute MI during the perioperative period. Patients with severe aortic stenosis also were more likely than patients with moderate stenosis to die or have an acute MI. After adjusting for cardiac risk factors, aortic stenosis remained a strong predictor for perioperative acute MI or death (odds ratio, 5.2).

The authors conclude that aortic stenosis is a risk factor for acute myocardial infarction and mortality during the perioperative period of noncardiac surgery. In addition, the more severe the aortic stenosis, the more predictive of complications it is. These findings must be considered when assessing patients before noncardiac surgery.

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