Perioperative risk reassessment of non-cardiac surgery during last 10 years in patients with asymptomatic significant aortic stenosis

Abstract

Abstract Background Aortic valve stenosis (AS) is a common geriatric disease and the number of patients with significant AS in need of non-cardiac surgery is expected to increase. Significant AS is considered a major risk factor for non-cardiac surgery. Method There were 113078 patients who underwent non-cardiac surgery with intermediate-to high risk in general anesthesia from 2011 to 2019 at our Medical Center. There were 221 patients with asymptomatic significant AS among this population. First, to investigate the effect of significant AS on adverse events after surgery, Major adverse cardiovascular events (MACE) and Perioperative adverse cardiovascular events (PACE) occurrences were compared in the control group and asymptomatic significant AS group. Second, in order find out the factors affecting the occurrence of MACE and PACE in patients with asymptomatic significant AS, patients with and without MACE and PACE were compared and multivariable analysis was performed in patients with asymptomatic significant AS. Result There was no significant difference between the three groups in the ratio of primary and secondary outcomes, MACE (p value 0.971) and PACE (p value 0.185). Outcomes such as cardiac death, arrest, myocardial infarction, and stroke were also not significantly different. Significant factors with MACE were coronary artery disease (OR* 6.256, 95% CI** [1.258 - 31.115], p value = 0.026) and cardiac damage stage (OR 9.241, 95% CI [1.314 - 64.976], p value = 0.025). Factors significantly associated with PACE were dialysis (OR 13.486, 95% CI [1.742 - 104.371], p value 0.013), arrhythmia (OR 11.219, 95% CI [3.474 - 36.231], p value <0.001), LVEF (OR 0.928, 95% CI [0.882 - 0.977], p value 0.004), and cardiac damage stage (OR 2.199, 95% CI [1.055 - 4.584], p value 0.036). MACE increased at LVEF less than 62.5% and PACE increased at LVEF less than 61.7%. Conclusion There 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 aortic stenosis is an important factor in perioperative risk of non-cardiac surgery.Perioperative outcome in 30 daysRisk factor analysis for PACE