Aortic stenosis surgery preoperative evaluation


 * Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

Preoperative Evaluation
The patient may need to have some tests before the procedure. The Cardiologist usually conducts a physical examination and diagnose the condition, he or she will assess the general health of the patient and will recommend the most appropriate treatment for the patient and if he or she needs surgery. Some of the tests that can be done before the procedure include:


 * Echocardiogram (Doppler echocardiogram).
 * Cardiac catheterization.
 * Chest X-ray.
 * Computed tomography (CT) scan.
 * Electrocardiogram (ECG).
 * Electrophysiology tests.
 * Exercise tests.
 * Holter monitor.
 * Magnetic resonance imaging (MRI).

Around 40% of patients with aortic stenosis that require surgery also have coronary artery disease. Usually coronary artery disease is treated at the same operation if CABG (Coronary artery bypass grafting) is indicated.

Studies showed that concurrent bypass surgery adds little morbidity to the valvular procedure and does not increase the mortality. The 2006 ACC/AHA guidelines on the treatment of valvular heart disease included recommendations for coronary angiography prior to valve surgery in those who are suspected to have coronary artery disease and in those at risk for coronary disease. A noninvasive angiography using computed tomography (CT) or magnetic resonance imaging may be an alternative.

Before the surgery:
 * The surgeon needs to know if the patient is taking any drugs, supplements, or herbs before the procedure.
 * The patient may be able to store blood in the blood bank for transfusions during and after the surgery. The family members can also donate blood (autologous donation).
 * For the 2-week period before surgery, the patient should be asked to stop taking drugs that make it harder for the blood to clot. These might cause increased bleeding during the surgery. Some of these drugs are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
 * The day before the surgery, the patient should shower and shampoo well and wash the whole body below the neck with a special soap.
 * The patient may also be asked to take an antibiotic to guard against infection.
 * The patient should be informed which drugs he or she should still take on the day of the surgery.
 * The patient should stop smoking.

On the day of the surgery:
 * An intravenous (IV) line will be placed into a blood vessel in the patient's arm or chest to give fluids and medicines.
 * The patient should be asked not to drink or eat anything after midnight the night before surgery. This includes chewing gum and using breath mints. The patient can rinse mouth with water if it feels dry without swallowing.
 * Make sure that the patient is taking the drugs that he or she needs to take with a small sip of water.
 * Hair near the incision site may be shaved immediately before the surgery.
 * The patient should be informed when to arrive to hospital on the day of the surgery.