Aortic stenosis - NYSORA

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Aortic stenosis

Learning objectives

  • Define and recognize aortic stenosis
  • Describe the pathophysiology of aortic stenosis and its consequences
  • Describe the general anesthetic management principles for aortic stenosis

Definition & mechanisms

  • Aortic stenosis occurs when the aortic valve narrows and blood cannot flow normally
  • Severe aortic stenosis is a risk factor for perioperative cardiac complications in non-cardiac surgery
  • There are several causal mechanisms:
    • Degenerative calcific aortic stenosis: Progressive fibrosis and calcification due to mechanical stress over time
    • Congenital bicuspid aortic valve: Abnormal valve structure, with two rather than three leaflets, which can produce fibrosis and calcifications
    • Rheumatic aortic stenosis: Long-term consequence of acute rheumatic fever

aortic stenosis pathophysiology, aortic valve, obstuction, hypertrophy, diastolic dysfunction, compliance, left ventricular diastolic pressure, left atrium atrophy, oxygen mismatch, dilatation, pressure gradient, cardiac failure, angina

Severity assessment

Aortic sclerosisMildModerateSevere
Peak velocity (m/s)<_2.5 m/s2.6–2.93.0–4.0≥4.0
Mean gradient (mmHg)-<2020–40≥40
AVA (cm2)->1.51.0–1.5<1.0
Indexed AVA (cm2
/m2)		->0.850.60–0.85<0.6
Velocity ratio->0.500.25–0.50<0.25

Anesthetic management

  • The severity and pathophysiology of aortic stenosis determine the anesthetic management plan
  • The following general principles apply:

echocardiographic assessment, aortic stenosis, left ventricular function, preoperative assessment, intraoperative, postoperative management, preload, afterload, contractility, bradycardia, tachycardia, sinus rhythm, blood pressure, heart rate, electrocardiograph, pulse oximetry, end tidal carbon dioxide, temperature, arterial catheter, central line, pulmonary artery catheter, entropy monitor, transesophageal echocardiography, hypotension, pain management

Keep in mind

  • All necessary medications and equipment to ensure stable vital signals and treat irregularities must be available during the procedure

Suggested reading

  • Schneider AC. A review of aortic stenosis: an anesthetic perspective. J Anesth Crit Care Open Access. 2018;10(6):262‒264. 
  • Baumgartner H Chair, Hung J Co-Chair, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 2017;18(3):254-275.
  • Brown J, Morgan-Hughes NJ. Aortic stenosis and non-cardiac surgery. Continuing Education in Anaesthesia Critical Care & Pain. 2005;5(1):1-4.

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