Aortic valve replacement in the octogenarians: perioperative outcome and clinical follow-up

Kolh, Philippe; Lahaye, Laurent; Gérard, Paul; Limet, Raymond

doi:10.1016/s1010-7940(99)00146-3

Cited by 105 publications

(77 citation statements)

References 18 publications

(22 reference statements)

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“…4-6, 10, 13, 15, 16 The outlook for this group of patients was excellent, with an expected survival normal for this particular age group and with good relief of symptoms. The actuarial survival rate at 5 years, in-hospital mortality excluded, of 91.1% (95% CI 86.7-95.5) is comparable with those of some series 8,11 and better than those of other studies reporting on hospital survivors. 10,13,[15][16][17] The most gratifying result in this study has been the improvement in these patients' quality of life, which is at least of equal importance as survival to the elderly.…”

Section: Long-term Outcomesupporting

confidence: 78%

“…3 The overall perioperative mortality of 14.5% in the present series is acceptable and comparable with the experience of other investigators. [4][5][6][7][8][9][10][11] Most of these studies included a variable proportion of patients who underwent simultaneous CABG or an additional valve procedure. These concomitant procedures in elderly patients undergoing AVR are known to be related to a significant increase in operative mortality.…”

Section: Operative Resultsmentioning

confidence: 99%

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Aortic valve replacement in patients 70 years and older

Salazar

Torres

Barragán

et al. 2004

Clinical Cardiology

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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.

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Section: Long-term Outcomesupporting

confidence: 78%

Section: Operative Resultsmentioning

confidence: 99%

Aortic valve replacement in patients 70 years and older

Salazar

Torres

Barragán

et al. 2004

Clinical Cardiology

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“…18,19 IBS could integrate conventional echo evaluation of LV function in two ways: (1) the cross-point of increase in IBS si over which degenerative myocardial alterations in LV hypertrophy could develop into CHF (see ROC), and (2) the initial functional CVI and IBSV alterations, which reflect the intrinsic myocardial contractility abnormalities. Both early impairment of IBS indexes, together with clinical findings (increasing dyspnea, inserting angina pectoris, or syncope) and Doppler evaluation of aortic stenosis hemodynamics, allow identification of the patients with CHF and aortic stenosis, separating them from those with cardiomyopathy and AS.…”

Section: Discussionmentioning

confidence: 99%

Severe Aortic Stenosis and Myocardial Function

et al. 2004

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Background— The aim of this study was to assess the myocardial reflectivity pattern in severe aortic valve stenosis through the use of integrated backscatter (IBS) analysis. Patients with aortic stenosis (AS) were carefully selected in the Department of Cardiology. Methods and Results— Thirty-five subjects (AS: valve orifice ≤1 cm 2 ; 12 female; mean age, 71.8±6.2 years) and 25 healthy subjects were studied. All subjects of the study had conventional 2D-Doppler echocardiography and IBS. Backscatter signal was sampled at the septum and posterior wall levels. Patients with AS were divided into 2 groups: 16 patients with initial signs of congestive heart failure and a depressed left ventricular systolic function (DSF) (ejection fraction [EF] range, 35% to 50%) and 19 asymptomatic patients with normal left ventricular systolic function (NSF) (EF >50%). Myocardial echo intensity (pericardium related) was significantly higher at the septum and posterior wall levels in DSF than in NSF and in control subjects. IBS variation, as an expression of variation of the signal, appeared to be significantly lower in AS with DSF than in NSF and in control subjects, at both the septum and posterior wall levels. Patients with DSF underwent aortic valve replacement, and, during surgical intervention, a septal myocardial biopsy was made for evaluation of myocardium/fibrosis ratio. Abnormally increased echo intensity was detected in left ventricular pressure overload by severe aortic stenosis and correlated with increase of myocardial collagen content (operating biopsy). Conclusions— One year after aortic valve replacement, we observed a significant reduction of left ventricular mass, and, only if pericardial indexed IBS value (reduction of interstitial fibrosis) decreased, it was possible to observe an improvement of EF and of IBS variation.

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“…Mortality in the hospital phase was the most important outcome. It varied between 1.5% (8) and 24% (9). These differences were due to large differences in patient characteristics such as age and co-morbid conditions.…”

Section: Resultsmentioning

confidence: 99%

“…A high preoperative functional class NYHA IV (14,15) and a low-flow low-gradient problem also could be related to a protracted burden, and hence a decreased left ventricular function. Coronary artery disease, previous and the need for concomitant CABG (9,11,12,15) as well as a previous myocardial infarction (10,11) and previous CABG (12) could add to a decrease in left ventricular function. Valvular factors such as severity of valvular disease and the type and size of valve prosthesis implanted also had an effect (15,16).…”

Section: Hospital or 30 Day Mortalitymentioning

confidence: 99%