| Valvular lesion | Heart rate | Heart rhythm | Preload | Afterload | Contractility | PVR |
| Aortic stenosis | - Normal HR at 60 to 80 bpm
- Avoid tachycardia
- Avoid bradycardia
| - Maintain sinus rhythm
- Avoid SVT, avoid AV dissociation
| - Maintain intravascular volume
- Avoid hypovolemia
| - Maintain systolic BP >100 mmHg, MAP >70 mmHg, or both within 20% of baseline
- Avoid hypotension
- Avoid severe or persistent hypertension
| - Avoid myocardial depression
| |
| Mitral stenosis | - Slow to normal HR at 50 to 70 bpm
- Avoid tachycardia
| - Control ventricular rate regardless of rhythm
| - Maintain intravascular volume
- Avoid hypovolemia
- Avoid hypervolemia
| - Maintain systolic BP >100 mmHg, MAP >70 mmHg, or both within 20% of baseline
- Avoid hypotension
| - Avoid myocardial depression, particularly RV depression owing to likely coexisting pulmonary hypertension
| - Avoid hypoxemia and hypercarbia
|
| Aortic regurgitation | - Normal to fast HR at 80 to 100 bpm
- Avoid bradycardia
| - Maintain relatively fast HR regardless of rhythm
| - Maintain or reduce preload
- Avoid hypervolemia
| - Maintain a low-normal systolic BP of approximately 100 to 120 mmHg or within 10% of baseline
- Avoid and/or immediately treat hypertension
| - Avoid myocardial depression
| |
| Mitral regurgitation | - For primary MR: Normal to fast HR at 80 to 100 bpm
- Avoid bradycardia
| - Maintain relatively fast HR regardless of rhythm
| - Maintain or reduce preload
- Avoid hypervolemia
| - Maintain a low-normal systolic BP of approximately 100 to 120 mmHg or within 10% of baseline
- Avoid and/or immediately treat hypertension
(In patients with MR due to ischemic heart disease, maintain a normal BP approximating preoperative values) | - Avoid myocardial depression
| - Avoid hypoxemia and hypercarbia
|
- For secondary MR: Slow to normal HR at 55 to 80 bmp
- Avoid tachycardia
- Avoid bradycardia
| - Control ventricular rate regardless of rhythm
| - Maintain intravascular volume
- Avoid hypervolemia
- Avoid hypovolemia
| - Maintain BP close to preoperative values
- Avoid and/or immediately treat hypertension
- Avoid hypotension
| - Avoid myocardial depression, particularly RV depression owing to likely coexisting pulmonary hypertension
| - Avoid hypoxemia and hypercarbia
|
| Mitral regurgitation due to hypertrophic cardiomyopathy with LVOT obstruction | - Normal HR at 60 to 80 bpm
- Avoid tachycardia
- Avoid bradycardia
| - Maintain sinus rhythm
- Avoid SVT
- Avoid AV dissociation
| - Maintain intravascular volume
- Avoid hypovolemia
| - Maintain systolic BP >100 mmHg, MAP >70 mmHg, or both within 20% of baseline
- Treat hypotension with vasoconstrictors without inotropic properties (eg, phenylephrine, vasopressin)
| - Decrease contractility by deepening anesthesia or administering beta blockers
- Avoid inotropic agents
| |
