To operate or not on elderly patients with aortic stenosis: the decision and its consequences

Abstract

Objective-To evaluate the application of guidelines in the decision making process leading to medical or surgical treatment for aortic stenosis in elderly patients. Design-Cohort analysis based on a prospective inclusive registry. Setting-205 consecutive patients (> 70 years) with clinically relevant isolated aortic stenosis and without serious comorbidity, seen for the first time in the Doppler-echocardiographic laboratories of three university hospitals in the Netherlands. Results-The initial choice was surgery in 94 patients and medical treatment in 111. Only 59% of the patients who should have had valve replacement according to the practice guidelines were actually oVered surgical treatment. These were mainly symptomatic patients under 80 years of age with a high gradient. Operative mortality (30 days) was only 2%. The three year survival was 80% in the surgical group (17 deaths among 94 patients) and 49% in the medical group (43/111). Multivariate analysis showed that only patients with a high baseline risk, mainly determined by impaired left ventricular function, had a significantly better three year survival with surgical treatment than with medical treatment. Conclusions-In daily practice, elderly patients with clinically relevant symptomatic aortic stenosis are often denied surgical treatment. This study indicates that a surgical approach, especially where there is impaired systolic left ventricular function, is associated with better survival.

Quality of life among patients with severe aortic stenosis

“…We did demonstrate that scores of the SF-36v2™ correspond well with the severity of symptoms according to [19] undergo AVR [10,12,20,23,24]. Exercise testing is highly underused and downgraded from a class 2a to a 2b recommendation in the ACC/AHA guidelines, although it is reported to elicit symptoms in approximately 37 % of patients with aortic stenosis who were previously regarded as 'asymptomatic' [8,25,26].…”

Factors Influencing the Prognosis of Octogenarians with Aortic Stenosis in the Advanced Aging Societies

“…1.5 cm 2 were included in the present study. This study protocol was approved by the ethical committee of Shimane University Faculty of Medicine.…”

“…The growth rate of the elderly population has continued to increase and the prevalence of AS sharply increases with age (1). Thus, as life expectancy grows longer, valvular heart disease in the elderly is becoming an increasingly important health issue (2), and the population of elderly AS patients is expected to grow in the future (3). With the growing number of elderly AS patients, the use of echocardiography and the acceptance of surgical procedures are increasing in this population.…”

Outcomes after Transcatheter Aortic Valve Implantation: a Single Center Registry of 350 Consecutive Cases

“…For symptomatic patients, surgical aortic valve replacement (SAVR) is the standard of care as a result of proven long-term efficacy and safety [3,4]. However, a substantial number of patients is not referred for SAVR because of a high operative risk, severe comorbidities or advanced age [5][6][7]. Patients with severe symptomatic AS managed conservatively have an extremely poor prognosis with an average survival of two to four years.…”