title: Aortic stenosis: an underestimated risk factor for perioperative complications in patients undergoing noncardiac surgery.
abstract: OBJECTIVE
  To determine the incidence of perioperative events in patients with aortic stenosis undergoing noncardiac surgery.
  
  
  METHODS
  We studied 108 patients with moderate (mean gradient, 25 to 49 mm Hg) or severe (mean gradient, > or =50 mm Hg) aortic stenosis and 216 controls who underwent noncardiac surgery between 1991 and 2000 at Erasmus Medical Center. Controls were selected based on calendar year and type of surgery. Details of clinical risk factors, type of surgery, and perioperative management were retrieved from medical records. The main outcome measure was the composite of perioperative mortality and nonfatal myocardial infarction.
  
  
  RESULTS
  There was a significantly higher incidence of the composite endpoint in patients with aortic stenosis than in patients without aortic stenosis (14% [15/108] vs. 2% [4/216], P <0.001). This rate of perioperative complications was also substantially higher in patients with severe aortic stenosis compared with patients with moderate aortic stenosis (31% [5/16] vs. 11% [10/92], P = 0.04). After adjusting for cardiac risk factors, aortic stenosis remained a strong predictor of the composite endpoint (odds ratio = 5.2; 95% confidence interval: 1.6 to 17.0).
  
  
  CONCLUSIONS
  Aortic stenosis is a risk factor for perioperative mortality and nonfatal myocardial infarction, and the severity of aortic stenosis is highly predictive of these complications.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Miklos D
authors.initials: MD
authors.lastname: Kertai
authors.forename: Manolis
authors.initials: M
authors.lastname: Bountioukos
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Ian R
authors.initials: IR
authors.lastname: Thomson
authors.forename: Fabiola
authors.initials: F
authors.lastname: Sozzi
authors.forename: Jan
authors.initials: J
authors.lastname: Klein
authors.forename: Jos R T C
authors.initials: JR
authors.lastname: Roelandt
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D015150:Echocardiography, Doppler; D005260:Female; D006305:Health Status Indicators; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D009426:Netherlands; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*