Chun Shing Kwok1, Rodrigo Bagur2, Muhammad Rashid1, Ronit Lavi3, Mario Cibelli4, Mark A de Belder5, Neil Moat4, David Hildick-Smith6, Peter Ludman7, Mamas A Mamas1. 1. Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK. 2. Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Division of Cardiology, London Health Sciences Centre, Department of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address: rodrigobagur@yahoo.com. 3. Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada. 4. Royal Brompton Hospital, London, UK. 5. The James Cook University Hospital, Middlesbrough, UK. 6. Sussex Cardiac Centre, Brighton & Sussex University Hospitals, Brighton, UK. 7. Queen Elizabeth Hospital, Birmingham, UK.
Abstract
BACKGROUND: Aortic stenosis (AS) poses a perioperative management dilemma to physicians looking after patients who require non-cardiac surgery. The objective of this review is to investigate mortality and adverse cardiovascular events in patients with and without AS who underwent non-cardiac surgery. METHODS: We searched MEDLINE and EMBASE for studies that evaluated mortality and adverse cardiovascular events in patients with and without AS who underwent non-cardiac surgery. Pooled risk ratios for mortality and adverse outcomes (myocardial infarction, stroke, heart failure, death) were calculated using the dichotomous analysis method and subgroup analysis was performed considering the effect of severity of AS and symptoms. RESULTS: We identified 9 relevant studies with 29,327 participants. Among studies of severe AS, there was no significant difference in mortality (RR: 1.49, 95%CI:0.85-2.61; P=0.16) associated with non-cardiac surgery, but there was a significant increase in the composite adverse outcome (RR: 2.30, 95%CI:1.33-3.97; P=0.003). When the analysis involved any other degree of AS, eight studies were included and the pooled results showed a significant increase in composite adverse outcome (RR: 1.64, 95%CI:1.23-2.19; P<0.001) and myocardial infarction (RR: 1.90, 95%CI:1.54-2.34; P<0.001). When patients with asymptomatic AS were considered, the pooled results of four studies suggested an increased risk of composite adverse outcomes (RR: 1.59, 95%CI:1.19-2.12; P=0.002) but not mortality, myocardial infarction, heart failure or stroke. CONCLUSIONS: Patients with AS undergoing non-cardiac surgery have not been shown to be at increased risk of mortality, but have significantly higher rates of adverse cardiovascular events compared to patients without AS.
BACKGROUND:Aortic stenosis (AS) poses a perioperative management dilemma to physicians looking after patients who require non-cardiac surgery. The objective of this review is to investigate mortality and adverse cardiovascular events in patients with and without AS who underwent non-cardiac surgery. METHODS: We searched MEDLINE and EMBASE for studies that evaluated mortality and adverse cardiovascular events in patients with and without AS who underwent non-cardiac surgery. Pooled risk ratios for mortality and adverse outcomes (myocardial infarction, stroke, heart failure, death) were calculated using the dichotomous analysis method and subgroup analysis was performed considering the effect of severity of AS and symptoms. RESULTS: We identified 9 relevant studies with 29,327 participants. Among studies of severe AS, there was no significant difference in mortality (RR: 1.49, 95%CI:0.85-2.61; P=0.16) associated with non-cardiac surgery, but there was a significant increase in the composite adverse outcome (RR: 2.30, 95%CI:1.33-3.97; P=0.003). When the analysis involved any other degree of AS, eight studies were included and the pooled results showed a significant increase in composite adverse outcome (RR: 1.64, 95%CI:1.23-2.19; P<0.001) and myocardial infarction (RR: 1.90, 95%CI:1.54-2.34; P<0.001). When patients with asymptomatic AS were considered, the pooled results of four studies suggested an increased risk of composite adverse outcomes (RR: 1.59, 95%CI:1.19-2.12; P=0.002) but not mortality, myocardial infarction, heart failure or stroke. CONCLUSIONS:Patients with AS undergoing non-cardiac surgery have not been shown to be at increased risk of mortality, but have significantly higher rates of adverse cardiovascular events compared to patients without AS.
Authors: Taishi Okuno; Caglayan Demirel; Daijiro Tomii; Gabor Erdoes; Dik Heg; Jonas Lanz; Fabien Praz; Rainer Zbinden; David Reineke; Lorenz Räber; Stefan Stortecky; Stephan Windecker; Thomas Pilgrim Journal: JAMA Netw Open Date: 2022-07-01