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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Aortic valve replacement in octogenarians: is biologic valve the unique solution?
Carlo de Vincentiis1, Alessia B Kunkl, Santi Trimarchi
1Cardiac Surgery Department, San Donato Hospital, Milan, Italy.
The Annals of Thoracic Surgery
|March 22, 2008
Summary
Octogenarians undergoing aortic valve replacement have acceptable risks and good quality of life. Mechanical prostheses offer a slightly higher survival rate compared to biologic ones in this elderly population.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Biomaterials Science
Background:
- Octogenarian patients often present with symptomatic aortic stenosis requiring aortic valve replacement (AVR).
- The choice between mechanical and biologic prostheses in this age group involves balancing risks and benefits.
- Evaluating long-term outcomes, including morbidity, mortality, and quality of life, is crucial for AVR in the elderly.
Purpose of the Study:
- To analyze and compare morbidity, mortality, and quality of life outcomes.
- To assess the long-term efficacy of mechanical versus biologic prostheses in octogenarian AVR patients.
- To determine the overall suitability and success of AVR in elderly individuals with severe aortic valve disease.
Main Methods:
- Retrospective analysis of 345 octogenarian patients (mean age 82 years) undergoing AVR between 1991 and 2005.
- Patients received either a bioprosthesis (n=200) or a mechanical prosthesis (n=145).
- Data collected included demographics, preoperative status (NYHA class, ejection fraction), associated procedures, operative mortality, and long-term follow-up (mean 40 months).
Main Results:
- In-hospital mortality was 7.5%, with no significant difference between prosthesis types (8.5% biologic vs. 6.2% mechanical).
- Long-term survival at 5 and 10 years was 61% and 21% overall, with significantly higher survival in the mechanical prosthesis group (p=0.03).
- Postoperative quality of life was excellent (96% in NYHA class I or II), with no significant difference in cerebrovascular event rates or quality-of-life scores between groups.
Conclusions:
- Surgical AVR in octogenarians is associated with acceptable operative risk and excellent long-term quality of life.
- Mechanical prostheses demonstrated a statistically significant, albeit slight, advantage in long-term survival for this patient cohort.
- The study supports AVR as a viable treatment option for symptomatic aortic stenosis in octogenarians, with mechanical valves showing a survival benefit.
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