[Recommendations for noncardiac surgery in aortic stenosis]

Area of Science:

• Cardiology
• Cardiac Surgery
• Anesthesiology

Context:

• Aortic stenosis (AS) is the most prevalent heart valve disease in Western nations, with incidence rising due to population aging.
• AS poses significant perioperative risks, particularly for older individuals undergoing noncardiac procedures.
• Effective management hinges on thorough preoperative assessment, including cardiac and general health evaluations.

Purpose:

• To outline the perioperative management strategies for patients with aortic stenosis undergoing noncardiac surgery.
• To emphasize the importance of multidisciplinary collaboration between cardiologists, anesthesiologists, and surgeons.
• To provide guidance on surgical sequencing based on AS severity and surgical urgency.

Summary:

• Preoperative evaluation for noncardiac surgery in AS patients must consider cardiac status, comorbidities, and surgical urgency.
• Non-severe AS allows noncardiac surgery first; severe AS with elective noncardiac surgery may warrant prior aortic valve replacement.
• Urgent noncardiac surgery in severe AS necessitates careful anesthetic management or consideration of percutaneous aortic valve commissurotomy.

Impact:

• Optimized perioperative outcomes for patients with aortic stenosis undergoing noncardiac surgery.
• Improved patient safety through tailored management strategies for high-risk surgical candidates.
• Enhanced communication and coordination among surgical and medical teams for complex cases.