Clinical Guidelines for the Perioperative Management of Patients with Aortic Stenosis Undergoing Noncardiac Surgery

Aortic stenosis (AS) is a common valvular disorder that causes left ventricular (LV) outflow obstruction. The prevalence of AS may increase with the aging population and the widespread availability of diagnostic capabilities like echocardiography. With the increasing patient population diagnosed with AS, the chance of encountering these patients during noncardiac surgery (NCS) increases. Performance of anesthesia is challenging in patients with AS due to the pathophysiological consequences of AS and the hemodynamic changes associated with anesthesia. The patient with AS presenting for NCS is at an increased risk of perioperative major adverse cardiac events (MACEs). This project aimed to determine the most up-to-date evidence for the perioperative management of patients with AS undergoing NCS. A literature search was conducted through the EBSCO Discovery Service and Google Scholar to find current evidence. The current evidence was used to create clinical guidelines for the pre and intraoperative management of patients with AS undergoing NCS using the Bayesian approach. The practice question, evidence, translation (PET), part of the Johns Hopkins Evidence-Based Practice Model (JHEBPM), was used as the literature review’s framework. An implementation plan to disseminate the guidelines into practice was formed and discussed. The outcome the project team aims to study is the incidence of MACEs in patients with AS undergoing NCS after the implementation of clinical guidelines. Keywords: aortic stenosis, noncardiac surgery, major adverse cardiac event, preoperative evaluation, intraoperative management