How does aortic stenosis (AS) affect perioperative cardiac management?

Updated: Feb 04, 2019
  • Author: Davinder Jassal, MD; Chief Editor: William A Schwer, MD  more...
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Answer

Answer

Aortic stenosis (AS) is associated with a 13% risk of perioperative death. Risk varies based on the severity of AS. The death rate associated with critical AS is approximately 50%.

While taking a history, the clinician should inquire about symptoms of syncope, angina, and dyspnea. During the examination, assess for a crescendo-decrescendo murmur in the right intercostal space radiating to the carotids. Pulsus parvus et pulsus tardus, a soft second heart sound (S2), a late peaking murmur, brachioradial delay, and an apical-carotid delay should raise the suggestion of AS. Critical AS is often characterized by an absent S2 and pulsus parvus et tardus. Echocardiography revealing an aortic valve area less than 0.7 cm2 and/or a mean gradient of 50 mm Hg/peak gradient of 80 mm Hg is deemed critical stenosis. The clinician should delay surgery, except for emergencies, and should consider preoperative valve replacement in these selected patients.


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