Aortic Stenosis and Noncardiac Surgery: Managing the Risk

Managing the risk of noncardiac surgery in patients with aortic stenosis is a problem that is frequently confronted in clinical practice. Traditionally, patients with severe aortic stenosis were considered to be at substantial risk during noncardiac surgery, and as such, elective procedures were avoided before intervention on the aortic valve in most patients other than those who were ineligible or refused aortic valve replacement. Recent data suggest that with contemporary anesthesia and surgical techniques, the risk of noncardiac surgery is substantially lower than previously believed. We review the existent literature in the field, and propose a practical approach to complex patients.