Aortic stenosis, individual of the...

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

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

There were 108 patients who met the criteria for moderate or chaste aortic stenosis during the period. These patients were compared with 216 hinder patients. Patients with aortic stenosis were significantly more likely than direction patients to die or have an acute MI during the perioperative period. Patients with strict 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 muscular predictor for perioperative acute MI or death (odd ratio, 52)

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

KARL E MILLER, MD

Kertai MD et al. Aortic stenosis: an underestimated risk factor for perioperative complications in patients undergoing noncardiac surgery Am J M January 1 2004;116:8-13

COPYRIGHT 2004 American Academy of Family Physicians

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