UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

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

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

INTRODUCTION

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".)

PREANESTHESIA CONSULTATION

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.

                                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Aug 2017. | This topic last updated: Jul 01, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.
  2. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:2215.
  3. Stott DK, Marpole DG, Bristow JD, et al. The role of left atrial transport in aortic and mitral stenosis. Circulation 1970; 41:1031.
  4. Sosis M, Cooper PS, Herr G. The diagnosis of "junctional rhythms" with halogenated anesthetics. Anesthesiology 1985; 63:233.
  5. Sethna DH, Deboer GE, Millar RA. Observations on 'junctional rhythms' during anaesthesia. Br J Anaesth 1984; 56:924.
  6. Zile MR, Gaasch WH. Heart failure in aortic stenosis - improving diagnosis and treatment. N Engl J Med 2003; 348:1735.
  7. Ross J Jr. Afterload mismatch in aortic and mitral valve disease: implications for surgical therapy. J Am Coll Cardiol 1985; 5:811.
  8. Kurup V, Haddadin AS. Valvular heart diseases. Anesthesiol Clin 2006; 24:487.
  9. American Society of Anesthesiologists. Standards for Basic Anesthetic Monitoring. www.asahq.org/Search.aspx?q=standards+basic+anesthetic+monitoring (Accessed on March 29, 2016).
  10. Mark JB. Multimodal detection of perioperative myocardial ischemia. Tex Heart Inst J 2005; 32:461.
  11. Gelman S. Venous function and central venous pressure: a physiologic story. Anesthesiology 2008; 108:735.
  12. Landoni G, Bignami E, Oliviero F, Zangrillo A. Halogenated anaesthetics and cardiac protection in cardiac and non-cardiac anaesthesia. Ann Card Anaesth 2009; 12:4.
  13. Raphael J. Physiology and pharmacology of myocardial preconditioning. Semin Cardiothorac Vasc Anesth 2010; 14:54.
  14. Agarwal B, Stowe DF, Dash RK, et al. Mitochondrial targets for volatile anesthetics against cardiac ischemia-reperfusion injury. Front Physiol 2014; 5:341.
  15. Uhlig C, Bluth T, Schwarz K, et al. Effects of Volatile Anesthetics on Mortality and Postoperative Pulmonary and Other Complications in Patients Undergoing Surgery: A Systematic Review and Meta-analysis. Anesthesiology 2016; 124:1230.
  16. Blaise G, Langleben D, Hubert B. Pulmonary arterial hypertension: pathophysiology and anesthetic approach. Anesthesiology 2003; 99:1415.
  17. Maron MS, Olivotto I, Harrigan C, et al. Mitral valve abnormalities identified by cardiovascular magnetic resonance represent a primary phenotypic expression of hypertrophic cardiomyopathy. Circulation 2011; 124:40.
  18. Thompson RC, Liberthson RR, Lowenstein E. Perioperative anesthetic risk of noncardiac surgery in hypertrophic obstructive cardiomyopathy. JAMA 1985; 254:2419.
  19. Frogel J, Galusca D. Anesthetic considerations for patients with advanced valvular heart disease undergoing noncardiac surgery. Anesthesiol Clin 2010; 28:67.
  20. Mittnacht AJ, Fanshawe M, Konstadt S. Anesthetic considerations in the patient with valvular heart disease undergoing noncardiac surgery. Semin Cardiothorac Vasc Anesth 2008; 12:33.
Topic Outline

GRAPHICS