Talk. Mumble. Mutter. Grapevine. Sussuration. Scuttlebutt. Whisper. Murmur. Undertone. Buzz. Hearsay. Hum. Purr. Drone. Brool. Cry. Rumble. Gossip. Rumor. The Case. 62 yo M, pre-op eval for total L hip replacement in 8 weeks Healthy, no cardiac or pulmonary history
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What do you want to do?
Oops, sorry – it was a hip fracture; he needs surgery tomorrow.
What do you want to do now?
Mercado (Medical Consultation Pearls, Hanley & Belfus, 2002; 39-41): “Perioperative mortality is modest and suggests that lifesaving or other urgent surgery not be denied to patients with critical aortic stenosis.”
1) Aortic stenosis is a risk factor for postop cardiac complications
2) The magnitude of the risk varies according to different risk indices
3) Patients with severe or critical aortic stenosis can undergo surgery with an acceptable degree of risk if the indication for surgery is sufficiently compelling