title: [Management of aortic stenosis in patients undergoing non-cardiac surgery].
abstract: There is a significant risk of cardiovascular morbidity and mortality in patients with severe aortic stenosis (valve area <1cm(2) or 0.6cm(2)/m(2) body surface area, and maximum jet velocity ≥4m/sec, and mean aortic pressure gradient ≥40mmHg) undergoing non-cardiac surgery, especially in patients with symptoms (dyspnoea, angina, syncope, or heart failure). Before any surgery, clinical assessment should search for signs of aortic stenosis which justifies echocardiographic examination, particularly in the elderly. A systematic rest echocardiography with searching aortic stenosis should be considered in patients undergoing high risk surgery. The key points of pre-operative cardiac risk assessment are: assessment of the severity of aortic stenosis, measurement of the functional capacity, evaluation of the left ventricular systolic function, search of associated coronary artery disease, estimate of the surgical risk of cardiac events, and achievement of risk indices. In symptomatic patients with severe aortic stenosis, only urgent non-cardiac surgery should be performed under careful haemodynamic monitoring. Aortic valve replacement should be considered before elective non-cardiac surgery. In asymptomatic patients with severe aortic stenosis, aortic valve replacement should be considered before non-cardiac high risk surgery. Non-cardiac surgery at low/intermediate risk can be performed provided an adapted anaesthetic technique.
authors.affiliation: Groupe hospitalier des hôpitaux universitaires de l'Est Parisien, AP-HP, hôpital Tenon, pôle thorax voies aériennes, unité de réanimation médico-chirurgicale, 75970 Paris cedex 20, France. Electronic address: vincent.labbe@tnn.aphp.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Labbé
authors.affiliation: Groupe hospitalier des hôpitaux universitaires de l'Est Parisien, AP-HP, hôpital Saint-Antoine, service de cardiologie, 75012 Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ederhy
authors.affiliation: Groupe hospitalier des hôpitaux universitaires de l'Est Parisien, AP-HP, hôpital Tenon, pôle thorax voies aériennes, service d'anesthésie-réanimation, 75970 Paris cedex 20, France.
authors.forename: Olga
authors.initials: O
authors.lastname: Szymkiewicz
authors.affiliation: Groupe hospitalier des hôpitaux universitaires de l'Est Parisien, AP-HP, hôpital Saint-Antoine, service de cardiologie, 75012 Paris, France.
authors.forename: Ariel
authors.initials: A
authors.lastname: Cohen
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D004452:Echocardiography; D017558:Elective Surgical Procedures / Q000009:adverse effects; D004632:Emergency Medical Services; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D014656:Vascular Surgical Procedures / Q000009:adverse effects