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Aortic stenosis and non-cardiac surgery: A systematic review and meta-analysis.

Abstract：

BACKGROUND:Aortic stenosis (AS) poses a perioperative management dilemma to physicians looking after patients who require non-cardiac surgery. The objective of this review is to investigate mortality and adverse cardiovascular events in patients with and without AS who underwent non-cardiac surgery. METHODS:We searched MEDLINE and EMBASE for studies that evaluated mortality and adverse cardiovascular events in patients with and without AS who underwent non-cardiac surgery. Pooled risk ratios for mortality and adverse outcomes (myocardial infarction, stroke, heart failure, death) were calculated using the dichotomous analysis method and subgroup analysis was performed considering the effect of severity of AS and symptoms. RESULTS:We identified 9 relevant studies with 29,327 participants. Among studies of severe AS, there was no significant difference in mortality (RR: 1.49, 95%CI:0.85-2.61; P=0.16) associated with non-cardiac surgery, but there was a significant increase in the composite adverse outcome (RR: 2.30, 95%CI:1.33-3.97; P=0.003). When the analysis involved any other degree of AS, eight studies were included and the pooled results showed a significant increase in composite adverse outcome (RR: 1.64, 95%CI:1.23-2.19; P<0.001) and myocardial infarction (RR: 1.90, 95%CI:1.54-2.34; P<0.001). When patients with asymptomatic AS were considered, the pooled results of four studies suggested an increased risk of composite adverse outcomes (RR: 1.59, 95%CI:1.19-2.12; P=0.002) but not mortality, myocardial infarction, heart failure or stroke. CONCLUSIONS:Patients with AS undergoing non-cardiac surgery have not been shown to be at increased risk of mortality, but have significantly higher rates of adverse cardiovascular events compared to patients without AS.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Kwok CS,Bagur R,Rashid M,Lavi R,Cibelli M,de Belder MA,Moat N,Hildick-Smith D,Ludman P,Mamas MA

doi

10.1016/j.ijcard.2017.04.037

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

145-153

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(16)34897-5

journal_volume

240

pub_type

杂志文章,meta分析,评审

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Aortic stenosis and non-cardiac surgery: A systematic review and meta-analysis.