Author + information
- Venkatesh Cheetirala,
- Karl Poterack,
- Harish Ramakrishna,
- Stephen Cha and
- Hari Chaliki
Background: Risk stratification of elderly symptomatic severe aortic stenosis(AS) patients who need emergent non-cardiac surgery can be problematic. Our objective was to determine the outcome of patients with symptomatic severe AS who underwent emergent non-cardiac surgery without aortic valve intervention prior to surgery.
Methods: We reviewed the surgical database at Mayo Clinic Hospital, Phoenix, Arizona from 2004 to 2016 to find patients who underwent emergency non-cardiac surgery. Five patients (83±13yrs) with symptomatic severe AS (cases) who were then compared to 25 patients (controls) of similar age (81±9yrs) with mild or no aortic stenosis. All patients had echocardiogram within 100 days of surgery. Gender (p=0.84), Charlson Co-morbidity Score (6.4 vs. 5.2;p=0.100) ejection fraction (64% vs. 55%; p=0.33), and type of surgery (p=0.40) were not different. Patients with symptomatic severe AS had an aortic valve area (AVA) of 0.9 ± 0.2 cm2 when compared to controls who had an AVA of 2.1±0.7cm2 (p=0.0004).
Results: Mean operative time was 125mins and 137mins in cases and Controls respectively (p=0.78). Intra-operatively, 4 Cases (80%) had hypotension requiring vasopressors while only 4 Controls (16%) (p=0.003) had hypotension. Mean hospital stay was not difference between cases and controls (8.6 days vs. 8.2days ; p=0.91). Heart failure post operatively occurred in 3 cases(60%) while none of the controls had heart failure (p=0.0004). There were no deaths intra-operatively or during immediate post-operative period. ICU stay required for 2 cases(40%) and 6 controls (24%) with mean duration of 11 days among cases and 11.1days in Controls(p=1.00).
Conclusions: Our study shows that symptomatic severe AS patients may be able to undergo urgent non cardiac surgery with acceptable morbidity and mortality. Although the patients with symptomatic severe AS experienced higher incidence of intra-operative hypotension and post-operative heart failure, non cardiac emergency surgery did not result in death in any of the patients. Close intra and post-operative monitoring likely improved outcome in these high risk patients. Further large prospective studies are needed.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Valvular Heart Disease: Aortic Stenosis
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1233-030
- 2017 American College of Cardiology Foundation