Stratégies de prise en charge périopératoire chez un opéré porteur d'un rétrécissement aortique calcifié

Sclerotic aortic stenosis has become more frequent with the growing age of the patients scheduled for non-cardiac surgery. Preoperative evaluation is focused on the severity of the aortic stenosis and its impact on myocardial function and coronary blood flow that determine the opportunity of aortic repair before non-cardiac surgery. Symptomatic patients have a higher risk of perioperative complications. The peroperative management aims to maintain ventricular preload and afterload and arterial blood pressure. Anaesthetic agents titration and the use of phenylephrine and norepinephrine aim to achieve this goal. Since postoperative mortality has decreased, aortic stenosis is no more a contra-indication to non-cardiac surgery.