Aortic Stenosis
Anesthetic Considerations
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Identify severity of disease & high risk markers (angina, syncope, CHF)
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↑ risk of perioperative cardiovascular complications (MI, CHF, arrhythmias)
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Hemodynamic consequences:
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Fixed LVOT obstruction with limited ability to ↑ cardiac output
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Hypertrophied ventricle with diastolic dysfunction
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Altered myocardial oxygen supply/demand
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Systolic dysfunction late in disease
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Associated complications:
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Coronary artery disease (CAD): 50% of patients with angina have concomitant CAD
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Other valvular disease
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Pulmonary hypertension
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Sudden cardiac death/malignant arrhythmia
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Potentially ineffective CPR
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Anemia/bleeding risk:
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Acquired von Willebrand syndrome
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Mucosal/GI angiodysplasias
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Always consider valvuloplasty/cardiology & cardiac surgery consult prior to semi-urgent/elective procedures
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Management of medications
Anesthetic Goals
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Preload: maintain adequate intravascular volume to fill non-compliant ventricular chamber (sensitive to volume depletion)
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Rate: low normal (maximize diastolic filling & coronary perfusion)
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Rhythm: sinus (atrial kick contributes up to 40% of total cardiac output)
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Contractility: maintain (prone to subendocardial ischemia (↑ muscle mass, ↓ coronary perfusion pressure)
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Afterload: maintain (coronary perfusion pressure)
Severity Scale
Further Reading
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Stoelting's Anesthesia and Co-Existing Disease, 7th Edition, Chapter 6
