Saturday, April 30, 2016

Non cardiac surgery in patients with aortic stenosis

Advances in perioperative management and the availability of transcutaneous techniques have improved the outlook for patients but have made decision making more complex. The topic is reviewed in this recent paper. Here is a key passage:

Emergency noncardiac surgery (NCS) obviously needs to be performed without consideration of the AS; these patients are at the highest risk of perioperative morbidity and mortality. Aortic balloon valvuloplasty (ABV) can be considered in patients needing urgent noncardiac surgery; transcatheter aortic valve replacement (TAVR) is an alternative, but the necessary assessment of vascular access and LVOT sizing cannot usually be performed in due time. Asymptomatic patients can in general proceed with elective noncardiac surgery; however, surgical aortic valve replacement (SAVR) or TAVR should be considered before high-risk surgical interventions, or in patients with revised cardiac risk index (RCRI) greater than or equal to 2. Symptomatic patients should in general undergo TAVR or SAVR before noncardiac surgery, unless the need for antithrombotic therapy required after TAVR or SAVR unduly delays or increases the risk of noncardiac surgery, or when the noncardiac surgery could decrease the risk of anticipated SAVR or TAVR for severe symptomatic aortic stenosis. Concomitant SAVR and noncardiac surgery can also be considered in selected patients (see the text for details).

The full text of the article is recommended.

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