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Updated: May 25, 2025

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Poor Sympathetic Compensation During Active Standing Increases the Risk of Morbidity-Mortality in the Post-Surgery of

Nydia Avila-Vanzzini1, Anayanci Santana-Ortiz2, Daniela Sánchez-Estrada2

  • 1Faculty of Health Sciences, Universidad Anahuac Mexico, Huixquilucan 52786, Mexico.

Biology
|February 26, 2025
PubMed

Insights

Poor sympathetic compensation and increased left ventricular mass in severe calcific aortic stenosis patients before aortic valve replacement predict postoperative complications or death. This highlights potential risk stratification markers.

Area of Science:

  • Cardiology
  • Autonomic Nervous System Function
  • Surgical Risk Assessment

Background:

  • Severe calcific aortic stenosis (SCAS) is associated with impaired sympathetic response to orthostatic stress.
  • The impact of this autonomic dysfunction on outcomes after aortic valve replacement (AVR) remains understudied.

Purpose of the Study:

  • To investigate the association between heart rate variability (HRV) response to an active orthostatic challenge before AVR and postoperative complications or death in SCAS patients.
  • To identify pre-operative predictors of adverse outcomes following AVR.

Main Methods:

  • Observational study involving 49 SCAS patients undergoing AVR.
  • Cardiac autonomic activity assessed via HRV analysis in supine and active standing positions.
  • Evaluation of sympathetic compensation during orthostatic challenge.

Main Results:

  • Patients experiencing postoperative complications or death (48.9%) exhibited greater left ventricular (LV) mass.
  • A smaller change in mean cardiac period and sympathetic predominance during active standing was observed in the outcome group.
  • Poor sympathetic compensation (OR=4.8) and increased LV mass (OR=1.03) were independently associated with adverse outcomes.

Conclusions:

  • Reduced sympathetic compensation to orthostatic stress and elevated LV mass are significant predictors of complications or mortality post-AVR in SCAS patients.
  • Preoperative HRV assessment during orthostatic challenge may offer novel criteria for surgical risk stratification in these patients.

Keywords:
aortic stenosisaortic valve replacementheart rate variability

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