Abstract 11557: Perioperative Risk of Hemodynamically Significant Aortic Stenosis
Introduction: Hemodynamically significant aortic stenosis (hsAS) is associated with increased risk for non-cardiac surgery. The impact of hsAS and left ventricular (LV) function on risk of major non-cardiac surgery in the current era is not known.
Hypothesis: We evaluated the perioperative risk in hsAS patients and the utility of echocardiography in predicting risk.
Methods: By crossing echo and surgical databases, we identified 307 patients with hsAS (area <1 cm2, mean gradient >40 mmHg or peak aortic velocity >4 m/sec) who underwent major non-cardiac surgery. Death, major adverse cardiac events (MACE) within 30 days post surgery, and 1year survival were determined from medical records.
Results: Mean age was 76 ± 11 years and there were 166 (54%) men. There were 19 deaths (6.2%; 6 cardiac, 13 non-cardiac) and 29 MACE (9.4%; 2 strokes, 7 myocardial infarctions, 4 VT/VF arrests, and the 19 deaths; 3 patients had multiple events) within 30 days. American Society of Anesthesiology (ASA) score, emergent surgery, and pre-existing regional wall motion abnormalities were predictors of death within 30 days by multiple stepwise logistic regression (AUC 0.73, p<0.05). Among patients with hsAS, AS severity (valve area, gradient, peak velocity, valvulo-arterial index), LV function (EF, cardiac index, stroke volume), and comorbidities (diabetes, HTN, pulmonary disease) did not impact early mortality. Survival at 1 year was predicted by a model with EF, ASA score, age, NYHA class, pulmonary disease and peak aortic velocity (AUC 0.83, p<0.05). EF<50 % was associated with significantly worse 1year survival independent of AS severity (see figure; moderate AS: AVA≥1.0 cm2, severe AS: AVA<1.0 cm2; p<0.006).
Conclusions: Patients with hsAS undergoing major non-cardiac surgery are at significant risk of death and MACE. Early perioperative risk is predicted by ASA score and need for emergent surgery. One year survival is strongly influenced by LV function and clinical factors.
- © 2012 by American Heart Association, Inc.