Aortic valve replacement in patients aged over 70 years

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Cardiac Valve Disease

Background:

• Elderly patients (over 70) often present with severe aortic valve disease (stenosis, combined, or regurgitation).
• Preoperative assessment revealed significant New York Heart Association (NYHA) functional class III or IV in most patients.
• Preoperative hemodynamic data indicated significant pressure gradients and preserved ejection fraction.

Purpose of the Study:

• To evaluate the outcomes of aortic valve replacement in patients over 70 years old.
• To compare the long-term efficacy and complications of mechanical versus bioprosthetic valves in this population.
• To assess functional capacity improvement and echocardiographic changes post-surgery.

Main Methods:

• A retrospective review of 58 patients over 70 undergoing aortic valve replacement over 12 years.
• Analysis of prosthesis type (37 mechanical, 21 biological), concomitant procedures (annular plasty, coronary bypass grafting).
• Assessment of hospital mortality, late mortality, complication rates (endocarditis, valve failure, embolic events), and functional status.

Main Results:

• Hospital mortality was 12%, primarily due to low output syndrome and infections.
• Late deaths were non-cardiac; 74% of mechanical valve patients and 62% of bioprosthesis patients were complication-free long-term.
• Tissue valves experienced prosthetic valve endocarditis and failure; embolic events were similar between groups. Echocardiography showed improved ejection fraction and regression of left ventricular hypertrophy.

Conclusions:

• Aortic valve replacement is associated with improved functional capacity in elderly patients.
• Mechanical valves demonstrated a better complication-free rate during follow-up compared to bioprostheses.
• While anticoagulation for mechanical valves carries risks, overall outcomes favor their use in selected elderly patients.