Survival after valve replacement for aortic stenosis: Implications for decision making

Abstract

To optimize survival, earlier aortic valve replacement should be considered even in asymptomatic patients before severe left ventricular hypertrophy or dysfunction develops. In younger patients, the largest possible prosthesis should be implanted to minimize residual gradient; in elderly patients, complex operations just to insert larger prostheses should be avoided.

Results of aortic valve surgery in patients over 75 years old, at 4.5 years of follow-up

“…Likewise, Mihaljevic et al [8] showed that, two years after aortic valve replacement, elderly patients have survival similar to that of the general population, matched for age, race and gender (85% survival at 2 years and 65% at 5 years for group of patients over 80 years).…”

“…Recent studies have shown that although the postoperative morbidity is higher in patients over 80 years, the late postoperative mortality is similar to younger patients, with 2-year survival comparable to that of the general population, matched for age and gender [7][8][9].…”

Recent developments for surgical aortic valve replacement: The concept of sutureless valve technology

“…Numerous observational studies have consistently demonstrated that corrective surgery in symptomatic patients is invariably followed by a subjective improvement in quality of life and a substantial increase in survival rates. In addition, AVR may also provide survival benefit for selected asymptomatic patients, when compared to conservative management [10][11][12][13][14][15][16]. The 2012 update of the ESC/EACTS Guidelines for the management of patients with valvular heart disease also states that aortic valve replacement may be considered for asymptomatic patients with severe aortic stenosis and abnormal response to exercise [17].…”

“…Mean length of hospital stay was 11 days [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. 30 day-mortality rate was 3.5%.…”

Classical methods to measure aortic valve area in the era of new invasive therapies: still accurate enough?

“…However, there are certain groups of patients who are denied surgery because of high risk of operative mortality [4]. Particularly, older age and left ventricular dysfunction have been related to high operative risk and poor outcome after aortic valve replacement [5,6].…”