From the Guidelines
Yes, aortic valve and aneurysm surgery can cause damage to heart muscle, as evidenced by the Valve Academic Research Consortium 3, which introduces a new category of complications to capture and classify injury of any cardiac structure occurring during the procedure 1. During these complex cardiac procedures, several factors can lead to heart muscle injury, including cardiac structure perforation, injury, or compromise, new pericardial effusion, and coronary obstruction, as outlined in Table 7 of the Valve Academic Research Consortium 3 study 1. The study highlights that cardiac structural complications can be major or minor, with major complications including cardiac structure perforation, injury, or compromise resulting in death, VARC type ≥ 2 bleeding, haemodynamic compromise or tamponade, or requiring unplanned surgical or percutaneous intervention 1. Some key points to consider include:
- Cardiac structure injury can involve the aortic annulus, left ventricle outflow tract, ventricular septum, left or right ventricle, left or right atrium, mitral valve apparatus, tricuspid valve apparatus, and coronary sinus 1
- New pericardial effusion can occur, resulting in death, VARC type ≥ 2 bleeding, haemodynamic compromise or tamponade, or requiring unplanned surgical or percutaneous intervention 1
- Coronary obstruction can result in death, haemodynamic compromise, myocardial infarction, or unplanned surgical or percutaneous intervention 1 However, modern surgical techniques, improved myocardial protection strategies, and careful perioperative management have significantly reduced the risk of permanent heart damage, and most patients recover well, though those with pre-existing heart disease face higher risks 1.
From the Research
Aortic Valve and Aneurysm Surgery Complications
- Aortic valve and aneurysm surgery can cause various complications, including damage to the heart muscle 2.
- The most common complications associated with resection of aneurysms of the thoracic and abdominal aorta are hemorrhage, acute renal failure, ischemic colitis, distal emboli, graft thrombosis, infection, pseudoaneurysm formation, aorto-caval and aorto-enteric fistulae, neurologic deficits, ureteral obstruction, sexual dysfunction, chylous ascites, and perigraft seroma 2.
Medical Therapy and Heart Muscle Damage
- Medical therapy after surgical aortic valve replacement, such as the use of renin-angiotensin system (RAS) inhibitors, statins, and β-blockers, can affect the risk of major adverse cardiovascular events, including heart muscle damage 3.
- Treatment with RAS inhibitors or statins was associated with a reduced risk of the primary outcome, including all-cause mortality, myocardial infarction, and stroke 3.
- However, β-blocker treatment was associated with an increased risk for the primary outcome, and its role needs to be further investigated 3.
Aneurysm Repair and Beta-Blocker Therapy
- The use of beta-blockers during aortic aneurysm repair has been debated, with some studies suggesting a beneficial effect on mortality 4.
- However, other studies have found that beta-blocker therapy does not reduce wall shear stress on the aneurysmal segment, which can contribute to heart muscle damage 5.
- Preoperative statin use has been associated with decreased odds of ascending aortic dilatation in patients with bicuspid aortic valve disease, which can reduce the risk of heart muscle damage 6.