Aortic stenosis: an underestimated risk factor for perioperative complications in patients undergoing noncardiac surgery

Purpose To determine the incidence of perioperative events in patients with aortic stenosis undergoing noncardiac surgery. Methods We studied 108 patients with moderate (mean gradient, 25 to 49 mm Hg) or severe (mean gradient, ≥50 mm Hg) aortic stenosis and 216 controls who underwent noncardiac surgery between 1991 and 2000 at Erasmus Medical Center. Controls were selected based on calendar year and type of surgery. Details of clinical risk factors, type of surgery, and perioperative management were retrieved from medical records. The main outcome measure was the composite of perioperative mortality and nonfatal myocardial infarction. Results There was a significantly higher incidence of the composite endpoint in patients with aortic stenosis than in patients without aortic stenosis (14% [15/108] vs. 2% [4/216], P<0.001). This rate of perioperative complications was also substantially higher in patients with severe aortic stenosis compared with patients with moderate aortic stenosis (31% [5/16] vs. 11% [10/92], P = 0.04). After adjusting for cardiac risk factors, aortic stenosis remained a strong predictor of the composite endpoint (odds RATIO = 5.2; 95% confidence interval: 1.6 to 17.0). Conclusion Aortic stenosis is a risk factor for perioperative mortality and nonfatal myocardial infarction, and the severity of aortic stenosis is highly predictive of these complications.