Conventional Aortic Valve Replacement for Elderly Patients in the Current Era

Abstract

Background: Because of the rising expectation of prolonged life in the general population and the recent recognition of undertreated aortic valve disease in the elderly, updating the available results of aortic valve surgery is imperative, especially considering the rapid evolution of the transcatheter valve implantation procedure. Methods and Results:Between 1997 and 2010, 308 patients aged 70 years or older underwent aortic valve replacement (AVR) for aortic stenosis (AS). Short- and long-term results were analyzed and risk factors for long-term mortality were determined. Mean age was 78.5 years and 124 patients were aged 80 or older. Concomitant coronary artery bypass grafting (CABG) was performed in 46% of the cases. Mean left ventricular ejection fraction (LVEF) was 52%. Overall observed and expected operative mortality using the Society of Thoracic Surgeons-Predicted Risk of Mortality score was 3.9% and 4.8%, respectively. Overall survival rates at 1, 5, and 10 years were 88.6%, 71.6%, and 31.8%, respectively. Predictors of long-term mortality included diabetes; preoperative shock; LVEF ≤40%; New York Heart Association functional class III or IV; and age.Conclusions: Short- and long-term results of conventional AVR in the elderly prove it to be durable and, especially in relatively low-risk patients and patients who require concomitant CABG, operative mortality is reasonably low. Conventional AVR ± CABG remains the gold standard for elderly patients with AS. (Circ J 2011; 75: 2692 - 2698

Clinical and Echocardiographic Correlates of Mortality in Medically Treated Patients With Severe Isolated Aortic Stenosis and Normal Left Ventricular Ejection Fraction

“…Given the relative low perioperative mortality in a contemporary series of similar patients undergoing AVR, 21 it is surprising that such a high proportion still fail to undergo valve replacement. Bach reported on 952 similar patients in a multicenter US cohort of whom 52% were referred for surgery but only 41% underwent AVR.…”

Impact of Ejection Fraction on Long-Term Outcome After Elective Aortic Valve Replacement in Octogenarians With Aortic Stenosis

“…Aortic stenosis (AS) is increasingly being diagnosed in octogenarians along with aging of the population and development of non-invasive diagnostic techniques, particularly 2-dimensional (2D) color Doppler echocardiography. 1- 4 The ACC/AHA guidelines states that the risk-benefit balance might change to favor earlier intervention for AS as improved valve substitutes are developed and methods of valve replacement become safer. 5 The current trend thus suggests that decision making on elective intervention in elderly patients with AS is gradually becoming more important due to recent invention of transcatheter aortic valve implantation.…”

Associations of residual left ventricular and left atrial remodeling with clinical outcomes in patients after aortic valve replacement for severe aortic stenosis

“…LV and LA reverse remodeling after AVR and the preoperative predictors AVR is the standard therapy for severe AS [25,26]. The marked reduction in LV afterload after AVR results in significant decreases in LV systolic and diastolic pressures [27].…”