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Review
. 2023 Apr 6:10:1145290.
doi: 10.3389/fcvm.2023.1145290. eCollection 2023.

Perioperative management of aortic stenosis in patients undergoing non-cardiac surgery

Roberto A Herrera  1 , Mark M Smith  2 , William J Mauermann  2 , Vuyisile T Nkomo  1 , Sushil Allen Luis  1
Affiliations
Review

Perioperative management of aortic stenosis in patients undergoing non-cardiac surgery

Roberto A Herrera et al. Front Cardiovasc Med. .

Abstract

Aortic stenosis is one of the most common cardiac valve pathologies in the world and its prevalence increases with age. Although previously associated with increased perioperative mortality, more recent studies suggest that mortality rates may be decreasing. Recent guidelines suggest that major non-cardiac surgery can be performed safely in asymptomatic severe aortic stenosis patients with close hemodynamic monitoring. Among symptomatic patients, the guidelines recommend aortic valve intervention prior to major non-cardiac surgery because of a reduction in the incidence of postoperative heart failure and improved rates of long-term overall survival. This review provides a comprehensive and contemporary review of the perioperative management of patients with severe aortic valve stenosis.

Keywords: aortic stenosis (AS); aortic valve replacement (AVR); non-cardiac surgery; outcomes; valvular heart disease (VHD).

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Conflict of interest statement

SL is a consultant for Medtronic, SOBI Pharmaceuticals, and Kiniksa Pharmaceuticals. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Suggested management algorithm for patients with severe aortic valve stenosis undergoing non-cardiac surgery. (B) Estimated procedural risk by surgery categorized according to ACC/AHA and ESC guidelines (6, 7). AVR, aortic valve replacement; BNP, brain natriuretic peptide; ECG, electrocardiogram; LVEF, left ventricular ejection fraction; TAVR, transcatheter aortic valve replacement; SAVR, surgical aortic valve replacement.
See this image and copyright information in PMC

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