Perioperative risk of non-cardiac surgery in patients with asymptomatic significant aortic stenosis: a 10-year retrospective study

BACKGROUND Aortic valve stenosis (AS) is a representative geriatric disease, and there is an anticipated rise in the number of patients requiring non-cardiac surgeries in patients with AS. However, there is still a lack of research on the primary predictors of non-cardiac perioperative complications in patients with asymptomatic significant AS. METHOD AND RESULT Among the cohort of non-cardiac surgeries under general anesthesia, with an intermediate-to-high risk of surgery from 2011 to 2019, at Samsung Medical Center, 221 patients were identified to have asymptomatic significant AS. First, to examine the impact of significant AS on perioperative adverse events, the occurrences of Major Adverse Cardiovascular Events (MACE) and Perioperative Adverse Cardiovascular Events (PACE) were compared between patients with asymptomatic significant AS and the control group. Second, to identify the factors influencing the perioperative adverse events in patients with asymptomatic significant AS, multivariable logistic regression model was used. There was no significant difference between the three groups consisting of control group, moderate asymptomatic AS group, and severe asymptomatic AS group in the event rate of MACE (p value 0.971) and PACE (p value 0.185). Cardiac damage stage was significant risk factor of MACE (OR 9.241, 95% CI: 1.314 - 64.976, p-value = 0.025) and PACE (OR 2.199, 95% CI: 1.055 - 4.584, p-value = 0.036). CONCLUSION There was no significant difference in major post-operative cardiovascular events between patients with asymptomatic significant AS and the control group. Advanced cardiac damage stage in significant AS is a key factor in perioperative risk of non-cardiac surgery. What Is New? Advanced cardiac damage is a major risk factor for perioperative complications in non-cardiac surgeries of patients with asymptomatic significant AS. What Are the Clinical Implications? Patients with asymptomatic significant AS showed no significant difference in perioperative complications compared to the control group, but caution is needed in those with advanced cardiac damage, as they are more likely to experience adverse events. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement There is no funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was approved by the Institutional Review Board of SMC and the requirement for informed consent from patients was waived. This study was conducted according to the principles of the Declaration of Helsinki (IRB No. 2021?06?078). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data that support the findings of this study are available from the corresponding author on reasonable request.