Perioperative risk of non-cardiac surgery in patients with asymptomatic significant aortic stenosis: a 10-year retrospective study

Abstract

ABSTRACTBACKGROUNDAortic valve stenosis (AS) is a representative geriatric disease, and there is an anticipated rise in the number of patients requiring non-cardiac surgeries in patients with AS. However, there is still a lack of research on the primary predictors of non-cardiac perioperative complications in patients with asymptomatic significant AS.METHOD AND RESULTAmong the cohort of non-cardiac surgeries under general anesthesia, with an intermediate-to-high risk of surgery from 2011 to 2019, at Samsung Medical Center, 221 patients were identified to have asymptomatic significant AS. First, to examine the impact of significant AS on perioperative adverse events, the occurrences of Major Adverse Cardiovascular Events (MACE) and Perioperative Adverse Cardiovascular Events (PACE) were compared between patients with asymptomatic significant AS and the control group. Second, to identify the factors influencing the perioperative adverse events in patients with asymptomatic significant AS, multivariable logistic regression model was used.There was no significant difference between the three groups consisting of control group, moderate asymptomatic AS group, and severe asymptomatic AS group in the event rate of MACE (p value 0.971) and PACE (p value 0.185). Cardiac damage stage was significant risk factor of MACE (OR 9.241, 95% CI: 1.314 - 64.976, p-value = 0.025) and PACE (OR 2.199, 95% CI: 1.055 - 4.584, p-value = 0.036).CONCLUSIONThere was no significant difference in major post-operative cardiovascular events between patients with asymptomatic significant AS and the control group. Advanced cardiac damage stage in significant AS is a key factor in perioperative risk of non-cardiac surgery.CLINICAL PERSPECTIVEWhat Is New?Advanced cardiac damage is a major risk factor for perioperative complications in non-cardiac surgeries of patients with asymptomatic significant AS.What Are the Clinical Implications?Patients with asymptomatic significant AS showed no significant difference in perioperative complications compared to the control group, but caution is needed in those with advanced cardiac damage, as they are more likely to experience adverse events.