Cardiac Risk in Patients Aged >75 Years With Asymptomatic, Severe Aortic Stenosis Undergoing Noncardiac Surgery

Anna M. Calleja, Subha Dommaraju, Rakesh Gaddam, Stephen Cha, Bijoy K. Khandheria, Hari P Chaliki

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1159-1163
Number of pages5
JournalAmerican Journal of Cardiology
Volume105
Issue number8
DOIs
StatePublished - Apr 15 2010

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Aortic Valve Stenosis
Hypotension
Cardiac Arrhythmias
Aortic Valve
Heart Failure
Myocardial Infarction
Anesthesia
Odds Ratio

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac Risk in Patients Aged >75 Years With Asymptomatic, Severe Aortic Stenosis Undergoing Noncardiac Surgery. / Calleja, Anna M.; Dommaraju, Subha; Gaddam, Rakesh; Cha, Stephen; Khandheria, Bijoy K.; Chaliki, Hari P.

In: American Journal of Cardiology, Vol. 105, No. 8, 15.04.2010, p. 1159-1163.

Research output: Contribution to journalArticle

Calleja, Anna M. ; Dommaraju, Subha ; Gaddam, Rakesh ; Cha, Stephen ; Khandheria, Bijoy K. ; Chaliki, Hari P. / Cardiac Risk in Patients Aged >75 Years With Asymptomatic, Severe Aortic Stenosis Undergoing Noncardiac Surgery. In: American Journal of Cardiology. 2010 ; Vol. 105, No. 8. pp. 1159-1163.
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abstract = "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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