Risk of noncardiac surgical procedures in patients with aortic stenosis

Although severe aortic stenosis has been reported to increase the risk of noncardiac operation, recent advances in anesthetic management may alter this risk. We reviewed the perioperative course of 48 consecutive patients (mean age, 73 years) with significant aortic stenosis who underwent a noncardiac operation or diagnostic procedure between 1985 and 1987. Twenty-five patients had local anesthesia with intravenous sedation, 22 (17 with severe and 5 with moderate aortic stenosis) underwent general anesthesia, and 1 had spinal anesthesia. Of the 48 patients, 36 (75%) had symptoms--congestive heart failure in 24, angina in 19, and syncope in 7. Doppler echocardiography, performed in all 48 patients, revealed a mean peak instantaneous gradient of 76 mm Hg and a calculated aortic valve area (in 22 patients) of 0.61 cm2. In the 20 patients who also underwent preoperative cardiac catheterization, the calculated mean aortic valve area was 0.59 cm2. Seven patients had one or more perioperative events, including intraoperative hypotension in five; all except one of these events were transient and without major sequelae. No intraoperative deaths occurred. Selected patients with severe aortic stenosis can undergo noncardiac procedures at a reasonably low risk with careful monitoring of anesthesia.