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Contemporary surgical or percutaneous management of severe aortic stenosis in the elderly

Fleur Descoutures1, Dominique Himbert, Laurent Lepage

  • 1Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018 Paris, France.

European Heart Journal
|March 8, 2008
PubMed

Insights

Elderly patients with severe aortic stenosis (AS) often present with high surgical risk. Percutaneous aortic valve interventions offer new treatment options for these high-risk individuals.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Severe symptomatic aortic stenosis (AS) poses a significant management challenge, particularly in elderly patients.
  • Traditional surgical valve replacement may not be suitable for all patients due to high operative risk.

Purpose of the Study:

  • To evaluate patient characteristics, treatment strategies, and outcomes for severe symptomatic AS at a tertiary center.
  • To assess the impact of on-site surgical and percutaneous valvular interventions.

Main Methods:

  • Retrospective analysis of 66 consecutive patients over 70 years old with severe AS.
  • Assessment of predicted surgical risk using logistic European System for Cardiac Operative Risk Evaluation and Society of Thoracic Surgeons-Predicted Risk of Mortality scores.
  • Evaluation of treatment pathways including surgical valve replacement, transfemoral aortic valve implantation, medical management, and valvuloplasty.

Main Results:

  • 59% of referred patients were deemed high-risk or inoperable.
  • Transfemoral aortic valve implantation was performed in 12 high-risk patients.
  • In-hospital mortality was 9%, with subsequent 6-month mortality of 10% among survivors, varying by treatment modality.

Conclusions:

  • A substantial proportion of elderly patients with severe AS are high-risk surgical candidates.
  • Percutaneous aortic valve interventions expand treatment options for elderly patients with severe AS.
  • Multidisciplinary evaluation is crucial for optimizing management in this complex patient population.
Abstract

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