Aortic valve replacement in patients 70 years and older

Abstract

SummaryBackground: Aortic valvular disease is the most common valvular lesion among elderly patients. Because of changing demographics, it has become increasingly frequent. Aortic valve replacement (AVR) is the only effective treatment for aortic valvular disease.Hypothesis: This study was undertaken to evaluate the results of AVR in an elderly population.Methods: Data were retrospectively analyzed in 117 consecutive patients (mean age 73.8 years) who underwent AVR between 1991 and 2002.Results: Pure or predominant severe aortic stenosis was present in 108 patients. Nine patients had severe aortic regurgitation. Before valve replacement, 62.4% of the patients were in New York Heart Association (NYHA) functional class III-IV. A bioprosthesis was implanted in 62.4% of the patients, and 37.6% received a mechanical valve. Concomitant cardiac surgical procedures were performed in 25 patients (coronary artery bypass graft in 22, mitral valve replacement in 3). There were 17 deaths, giving a perioperative mortality rate of 14.5%. Multivariate logistic regression showed that repeat surgery for bleeding, prolonged cardiopulmonary bypass time, postoperative respiratory failure, and postoperative acute renal insufficiency were significant independent predictors of operative mortality. Of the 100 hospital survivors, 78 were followed for a mean of 42.9 months. There were six deaths during followup; only two of these were cardiac related. Five-year actuarial survival for all patients and for hospital survivors were 70 and 91.1%, respectively. One year post surgery, all patients were in NYHA functional class I-II.

A systematic review on the quality of life benefits after aortic valve replacement in the elderly

“…17 The challenge of surgery in this population is to provide a good HRQOL in the mid-to long-term. Evidence is accumulating on the positive HRQOL outcomes after AVR, 8,12,14,15,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] and it remains the only effective treatment option for aortic valve disease. 29 AVR is also highly cost-effective in the elderly population, 33 patients.…”

New technique of local ischemic preconditioning induction without repetitive aortic cross-clamping in cardiac surgery

“…Although the number of open heart surgeries performed each year has declined in the past decade, the proportion of very elderly patients with multiple comorbidities and/or multivessel coronary artery disease (CAD) undergoing major heart surgery is continuously increasing [ 1 ]. The peri- and postoperative mortality and morbidity has been reported to be increased in this patient population [ 2 , 3 ], which may be attributed—at least in part—to suboptimal myocardial protection due to a longer duration of aortic cross-clamping in advanced CAD [ 4 ], as well as the enhanced susceptibility of the aged and diabetic myocardium to ischemia–reperfusion injury (IRI) [ 5 , 6 ]. Therefore, the development and application of new cardioprotective approaches in cardiac surgery remains important.…”

Influência da doença aterosclerótica arterial coronária crítica na mortalidade hospitalar de pacientes portadores de estenose aórtica submetidos à substituição valvar

“…Salazar et al 42 analisando série de 117 pacientes consecutivos, com mais de 70 anos de idade, operados entre 1991 e 2002, descreveram mortalidade operatória de 14,5%, resultados similares aos obtidos por Mistiaen et al 43 e Bouma et al 44 .…”

“…Nos últimos 25 anos, vários autores 38,42,43,47,75 revisaram os resultados do tratamento cirúrgico combinado (substituição valvar aórtica e revascularização do miocárdio), com conclusões conflitantes, o que se deveu, em parte, a presença de possíveis dados de confusão e suas interações em grupos específicos de pacientes.…”

“…Em grandes séries de pacientes, a idade influenciou a mortalidade operatória 37,42,47,60,75,76,77 . Em 1993, Iung et al 64 Insuficiência cardíaca congestiva avançada (classe funcional III/IV) e baixa fração de ejeção do venrículo esquerdo foram apontadas como fator de risco de óbito por diferentes autores 16,38,40,45,46,81,82 , em discordância dos resultados descritos por Melby et al 70 .…”