Kwok, CS, Bagur, R, Rashid, M, Lavi, R, Cibelli, M, De Belder, M, Moat, N, Hildick-Smith, D, Ludman, P and Mamas, MA ORCID: 0000-0001-9241-8890 (2017) Aortic Stenosis and Non-Cardiac Surgery: A Systematic Review and Meta-Analysis. International Journal of Cardiology, 240. pp. 145-153. ISSN 1874-1754

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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.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://dx.doi.org/10.1016/j.ijcard.2017.04.037 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Aortic stenosis, non-cardiac surgery, mortality, adverse cardiovascular outcomes
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 11 Apr 2017 11:01
Last Modified: 22 Jun 2018 13:36
URI: http://eprints.keele.ac.uk/id/eprint/3208

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