Seminars in Cardiothoracic and Vascular Anesthesia

 

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This version was published on March 1, 2008
Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 12, No. 1, 33-59 (2008)
DOI: 10.1177/1089253208316442
© 2008 SAGE Publications and the British Sociological Association

Anesthetic Considerations in the Patient With Valvular Heart Disease Undergoing Noncardiac Surgery

Alexander JC Mittnacht, MD

Department of Anesthesiology, Mount Sinai Medical Center, New York, alexander.mittnacht{at}msnyuhealth.org

Michael Fanshawe, MD

University of Queensland, Brisbane, Australia

Steven Konstadt, MD, MBA, FACC

Department of Anesthesiology, Maimonides Medical Center, Brooklyn New York

Valvular heart disease can be an important finding in patients presenting for noncardiac surgery. Valvular heart disease and resulting comorbidity, such as heart failure or atrial fibrillation, significantly increase the risk for perioperative adverse events. Appropriate preoperative assessment, adequate perioperative monitoring, and early intervention, should hemodynamic disturbances occur, may help prevent adverse events and improve patient outcome. This review article aims to guide the practitioner in the various aspects of anesthetic management in the perioperative care of patients with valvular heart disease. The pharmacological approach to optimization of patient outcome with drugs, such as βblockers and lipid-lowering medications (statins), is an evolving field, and recent developments are discussed in this article.

Key Words: valvular disease • aortic stenosis • mitral stenosis • aortic insufficiency • mitral regurgitation • noncardiac surgery


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