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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Aortic valve replacement for aortic stenosis in nonagenarians
William Clifford Roberts1, Jong Mi Ko, Gregory John Matter
1Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Dallas, Texas 75246, USA. wc.roberts@baylorhealth.edu
The American Journal of Cardiology
|October 24, 2006
Summary
Severe aortic stenosis (AS) is treatable in nonagenarians with aortic valve replacement (AVR). This study examined clinical and morphologic findings in 9 patients aged 90+ undergoing AVR for AS.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Aortic stenosis (AS) is a significant condition in the elderly.
- Aortic valve replacement (AVR) is a treatment option for severe AS.
- Outcomes in nonagenarians undergoing AVR are less understood.
Purpose of the Study:
- To review clinical and morphologic findings in nonagenarian patients undergoing AVR for AS.
- To assess the severity of AS and associated valve morphology in this age group.
- To evaluate early and late outcomes following AVR in patients aged 90 years and older.
Main Methods:
- Retrospective review of 9 patients aged >=90 years who underwent AVR for AS between February 2000 and April 2006.
- Analysis of clinical data including aortic valve area, transvalvular gradients, and left ventricular ejection fraction.
- Morphologic assessment of excised aortic valves, noting bicuspid valves and weight.
Main Results:
- Aortic valve areas ranged from 0.41 to 1.00 cm2, with peak systolic gradients from 20 to 110 mm Hg.
- Left ventricular ejection fraction was >=50% in 6 of 9 patients.
- Three patients had congenitally bicuspid aortic valves (mean weight 6.56g); six had tricuspid valves (mean weight 1.73g).
- Coronary artery bypass grafting (CABG) was performed concurrently in 8 patients.
- One patient died postoperatively; two died late (874, 1011 days). Two required extended postoperative nursing care.
Conclusions:
- Severe aortic stenosis is prevalent in nonagenarians and can be associated with congenitally bicuspid aortic valves.
- AVR is feasible in this elderly population, though outcomes vary.
- Careful patient selection and surgical planning are crucial for managing AS in nonagenarians.
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