Objective

To compare the incidence of major adverse cardiac events and death among severe aortic stenosis patients with and without aortic valve replacement (AVR) before noncardiac surgery.

Patients and Methods

We retrospectively evaluated 491 severe aortic stenosis patients undergoing non-emergency/non-urgent elevated-risk noncardiac surgery between January 1, 2000, and December 31, 2013, including 203 patients (mean age, 74±10 years, 63.5% men) with previous AVR and 288 patients (mean age, 77±12 years, 55.6% men) without prior AVR.

Results

The incidence of major adverse cardiac events was significantly lower in the AVR group (5.4% vs 20.5%; P<.001), primarily because of the lower incidence of new or worsening heart failure (2.5% vs 17.7%; P<.001), compared with the non-AVR group. No significant differences were observed between the groups with and without AVR in the incidence of death (2.5% vs 3.5%; P=.56), myocardial infarction (0.5% vs 1.4%; P=.48), ventricular arrhythmia (0.0% vs 0.7%; P=.51), or stroke (0.0% vs 0.7%; P=.51) at 30-days. At a median follow-up of 4.2 (interquartile range,1.3-7.5) years, overall mortality was significantly worse in patients without versus with AVR (5-year rate: 57.0% vs 32.7%; P<.001). Symptomatic patients without AVR (n=35) had the worst outcomes overall, including increased 30-day and overall mortality rates, compared with the AVR-group and asymptomatic non-AVR patients.

Conclusion

In patients with severe aortic stenosis, AVR before noncardiac surgery was associated with decreased incidence of heart failure after noncardiac surgery and improved overall survival without differences in 30-day survival, myocardial infarction, ventricular arrhythmia, or stroke. Preoperative AVR should be considered in symptomatic patients for whom the benefit of AVR is greatest.

中文翻译：

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严重非主动脉手术后严重主动脉瓣狭窄的主动脉瓣置换术的影响。

目的

比较非心脏手术前有无主动脉瓣置换术（AVR）的严重主动脉瓣狭窄患者的主要不良心脏事件和死亡的发生率。

患者和方法

我们回顾性分析了2000年1月1日至2013年12月31日期间接受非急诊/非急诊高危非心脏手术的491例严重主动脉瓣狭窄患者，其中203例患者（平均年龄74±10岁，男性63.5％）既往没有AVR的288例患者（平均年龄77±12岁，男性55.6％）。

结果

AVR组主要不良心脏事件的发生率显着较低（5.4％vs 20.5％；P <.001），这主要是由于新发或恶化的心力衰竭发生率较低（2.5％vs 17.7％；P <.001） ），而非非AVR组。有无AVR组之间的死亡发生率（2.5％比3.5％；P = .56），心肌梗塞（0.5％比1.4％；P = .48），室性心律失常（0.0％）没有显着差异。vs. 0.7％；P = 0.51），或30天的中风（0.0％vs 0.7％；P = 0.51）。在中位随访期为4.2（四分位间距为1.3-7.5）年时，无AVR的患者的总死亡率显着更差（5年率：57.0％对32.7％； AVR较AVR）低。P <.001）。与AVR组和无症状的非AVR患者相比，没有AVR的有症状患者（n = 35）总体上最差的结果，包括30天死亡率和总死亡率增加。

结论

在患有严重主动脉瓣狭窄的患者中，非心脏手术前的AVR与非心脏手术后心力衰竭的发生率降低，总生存期延长，30天生存期，心肌梗塞，室性心律不齐或中风无差异有关。有症状的患者应考虑术前AVR，因为AVR的益处最大。