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Anesthesia for noncardiac surgery in patients with aortic or mitral valve disease

Manuel L Fontes, MD
Section Editors
Roberta Hines, MD
Jonathan B Mark, MD
Deputy Editor
Nancy A Nussmeier, MD, FAHA


Valvular heart disease (VHD) increases with age, and more than 13 percent of adults ≥75 years old have moderate or severe disease of one or more cardiac valves (table 1). The most common lesions are aortic stenosis (AS) due to degeneration and calcification of the valve in older adults or early calcification of a congenital bicuspid aortic valve, and mitral regurgitation (MR) due to primary causes (eg, intrinsic disease of the mitral leaflets or subvalvular apparatus) or secondary functional causes (eg, cardiomyopathy with left ventricular enlargement and annular dilatation or ischemic [postinfarction] MR) (figure 1). Patients often have a combination of stenosis and regurgitation in a single cardiac valve, or disease of more than one valve. (See "Valvular heart disease in elderly adults".)

This topic will discuss anesthetic management during elective or urgent noncardiac surgery in patients with moderate or severe aortic or mitral valve lesions. Many older adults with VHD have coexisting heart failure or ischemic heart disease. Additional anesthetic considerations for noncardiac surgery in patients with these comorbidities are addressed separately. (See "Anesthesia for noncardiac surgery in patients with heart failure" and "Anesthesia for noncardiac surgery in patients with ischemic heart disease".)

Anesthetic considerations in patients with abnormal cardiac anatomy and physiology due to congenital heart disease (CHD) are discussed in a separate topic. (See "Anesthesia for adults with congenital heart disease undergoing noncardiac surgery".)

Anesthetic considerations during labor and delivery in women with VHD, CHD, heart failure, or other high-risk heart disease are addressed separately. (See "Anesthesia for labor and delivery in high-risk heart disease: General considerations" and "Anesthesia for labor and delivery in high-risk heart disease: Specific lesions".)


The preanesthetic consultation for patients with valvular heart disease (VHD) involves assessing cardiac and overall health risks, identifying issues that may cause perioperative problems, working with the cardiologist and surgeon to optimize medical conditions, and developing an anesthetic care plan to provide appropriate hemodynamic conditions and avoid cardiovascular complications.

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Literature review current through: Oct 2017. | This topic last updated: Sep 26, 2017.
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