Aortic Stenosis

 

 

Anesthetic Considerations 

 

  • Identify severity of disease & high risk markers (angina, syncope, CHF)

  • ↑ risk of perioperative cardiovascular complications (MI, CHF, arrhythmias)

  • Hemodynamic consequences:

    • Fixed LVOT obstruction with limited ability to ↑ cardiac output

    • Hypertrophied ventricle with diastolic dysfunction

    • Altered myocardial oxygen supply/demand

    • Systolic dysfunction late in disease

  • Associated complications:

    • Coronary artery disease (CAD): 50% of patients with angina have concomitant CAD

    • Other valvular disease

    • Pulmonary hypertension 

    • Sudden cardiac death/malignant arrhythmia

    • Potentially ineffective CPR

    • Anemia/bleeding risk: 

      • Acquired von Willebrand syndrome

      • Mucosal/GI angiodysplasias 

  • Always consider valvuloplasty/cardiology & cardiac surgery consult prior to semi-urgent/elective procedures 

  • Management of medications

 

 

Anesthetic Goals

 

  • Preload: maintain adequate intravascular volume to fill non-compliant ventricular chamber (sensitive to volume depletion)

  • Rate: low normal (maximize diastolic filling & coronary perfusion)

  • Rhythm: sinus (atrial kick contributes up to 40% of total cardiac output)

  • Contractility: maintain (prone to subendocardial ischemia (↑ muscle mass, ↓ coronary perfusion pressure)

  • Afterload: maintain (coronary perfusion pressure)

 

Severity Scale 

Further Reading 

  • Stoelting's Anesthesia and Co-Existing Disease, 7th Edition, Chapter 6

 

 

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