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J Thorac Cardiovasc Surg. 2019 Feb 13. pii: S0022-5223(19)30350-2. doi: 10.1016/j.jtcvs.2018.12.108. [Epub ahead of print]

Preoperative β-blocker use correlates with worse outcomes in patients undergoing aortic valve replacement.

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Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va.
Virginia Cardiac Services Quality Initiative, Virginia Beach, Va.
Inova Heart and Vascular Institute, Falls Church, Va.
Department of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Va.
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va. Electronic address:



β-Blocker use is associated with fewer cardiac complications in patients undergoing noncardiac surgery and is a quality metric for coronary artery bypass grafting. We sought to determine the influence of preoperative β-blocker administration before aortic valve replacement (AVR).


All patients undergoing isolated AVR from 2002 to 2016 were extracted from a multi-institutional, statewide database composed of Society of Thoracic Surgeons data. Patients were propensity score matched by preoperative and operative variables, and the effects of preoperative β-blockers on outcomes were assessed.


Of 7380 eligible patients, 53% received a preoperative β-blocker. After propensity matching, a total of 4592 patients were well matched (1:1) with minimal baseline differences between groups. Within the matched cohort, the operative mortality rate (β-blocker: 2.8% vs no β-blocker: 2.4%; P = .454) and rate of major morbidity (14.4% vs 12.7%; P = .101) were similar between groups. The rates of cardiac arrest (2.1% vs 1.3%; P = .034), renal failure requiring dialysis (1.7% vs 0.9%; P = .007), and postoperative transfusion (38.2% vs 33.8%; P = .002) after AVR were significantly greater in the cohort receiving preoperative β-blockade. Postoperative atrial fibrillation was also more prevalent in patients receiving a preoperative β-blocker (26.9% vs 23.4%; P = .007). Finally, preoperative β-blocker use was associated with longer postoperative intensive care unit stays (45.2 vs 47.0 hours; P = .001), but clinically similar hospital length of stay.


Preoperative β-blocker administration is not associated with improved outcomes after AVR but instead is associated with increased postoperative morbidity. Routinely initiating preoperative β-blockade is not supported in patients undergoing AVR.


aortic valve replacement; beta-blocker; perioperative management

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