A 62-year-old man with severe aortic stenosis (valve area 0.7 cm², mean gradient 52 mmHg) is scheduled for elective total hip replacement. Which of the following haemodynamic goals is MOST critical to maintain intraoperatively?
- A High heart rate (90–110 bpm) to maintain cardiac output
- B Permissive hypotension to reduce afterload across the stenotic valve
- C Normal sinus rhythm with adequate preload and avoidance of tachycardia ✓
- D Aggressive reduction of systemic vascular resistance with vasodilators
Correct answer: C. Normal sinus rhythm with adequate preload and avoidance of tachycardia
Explanation
Severe aortic stenosis demands maintenance of normal sinus rhythm, adequate preload (to fill the non-compliant hypertrophied LV), and avoidance of tachycardia (reduces diastolic filling time). The fixed cardiac output in AS means tachycardia and hypotension are particularly dangerous. Vasodilation and reduced SVR are harmful because the hypertrophied LV cannot augment stroke volume to compensate; tachycardia reduces coronary perfusion time worsening subendocardial ischaemia.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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