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Aortic Stenosis in Noncardiac Surgery

Aortic stenosis is the most common valvular lesion in patients older than 65 years, occurring in 2%–9% of patients. It is estimated that the number of patients with aortic stenosis who will need surgery will increase dramatically as the world’s population ages. Treatment of aortic stenosis includes surgical aortic valve replacement, transcatheter aortic valve replacement, balloon valvuloplasty, or medical management. Aortic stenosis is associated with significant perioperative risk in noncardiac surgery. Hemodynamic changes from anesthesia medications and the surgical procedure can result in decreased coronary perfusion, myocardial ischemia, arrhythmias, heart failure, or even death. General or regional anesthesia can be administered safely to asymptomatic patients with significant aortic stenosis if hemodynamics are maintained in the perioperative period.