Clinical Disease

cardiac

High-impact pattern

Severe Aortic Stenosis — Anesthetic Management

Fixed LV outflow obstruction; preload-dependent, afterload-intolerant ventricle with narrow hemodynamic corridor

Severe aortic stenosis is a fixed LV outflow obstruction (AVA <1.0 cm², Vmax ≥4.0 m/s, or mean gradient ≥40 mmHg) producing a preload-dependent, afterload-intolerant ventricle where tachycardia, hypotension, atrial fibrillation, and venodilation can precipitate acute decompensation and arrest.

If you forget

HEADLINE: Severe AS = narrow hemodynamic corridor — preserve sinus rhythm, preload, afterload, and a slow-to-moderate rate.

Board trap

Severe AS patients with new atrial fibrillation often decompensate because atrial kick contributes up to 30–40% of LV filling across a stiff, hypertrophied ventricle — cardiovert early if hemodynamically unstable, do not 'rate-control and wait'.

Key numbers

AVA <1.0 cm² → severe
Vmax ≥4.0 m/s → severe
Mean gradient ≥40 mmHg → severe
SVi <35 mL/m² → low flow
SBP goal ≥90 mmHg intraop
MAP goal ≥60–65 mmHg intraop
MSCT calcium score <1600 men / <800 women → severe AS unlikely
Echo surveillance every 6–12 mo when asymptomatic severe (Vmax ≥4 m/s)

Reviewed Sep 24, 2026 for clinical accuracy by BoardsBridge Editorial Process

Uri Rozen, MD — Licensed Physician, Israel

Source guidelines: AHA ACC Perioperative Cardiovascular 2024 · AHA ACC Perioperative Cardiovascular 2024 · AHA ACC Perioperative Cardiovascular 2024 · ACC AHA Valvular Heart Disease 2020

Re-review cadence: 12 months from reviewed date.

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Related on BoardsBridge

Card ID: as-severe · Path: aba.cardiac.valvular.as-severe