Perioperative Management of a Patient with Severe Aortic Stenosis and Chronic Obstructive Pulmonary Disease Undergoing Abdominal Aortic Aneurysm Repair: A Case Report

Introduction And Importance: Severe aortic stenosis (AS) and chronic obstructive pulmonary disease (COPD) significantly increase perioperative morbidity and mortality. This case report discusses the challenges of managing a 75-year-old male patient with severe AS and advanced COPD undergoing elective abdominal aortic aneurysm (AAA) repair.

Case Presentation: The patient presented with a 6.5 cm infrarenal AAA identified during routine surveillance. His medical history included severe AS (valve area 0.7 cm) and advanced COPD (FEV1 45 % of predicted). A multidisciplinary team developed a management plan that included pulmonary rehabilitation and cautious medication use. On the day of surgery, general anaesthesia was induced, with invasive haemodynamic monitoring established to maintain stability. Norepinephrine was titrated to achieve a mean arterial pressure of 70-80 mmHg, while fluid management was carefully monitored to prevent volume overload. The AAA repair was completed successfully without major complications.

Clinical Discussion: This case highlights the complexities of managing patients with severe AS and COPD during major surgery. Effective fluid management and lung-protective ventilation strategies minimized respiratory complications. Postoperatively, non-invasive ventilation facilitated early extubation and improved respiratory function.

Conclusion: This case underscores the importance of a multidisciplinary approach in managing complex patients with significant comorbidities. Collaboration among specialists is vital to optimize outcomes in patients undergoing major surgical interventions.