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[The results after prosthetic aortic valve replacement. What effect does old age have?]
F Schwarz1, K Metentzidou, K Giokoglu
1Abteilung Kardiologie, Rotes-Kreuz-Krankenhaus, Frankfurt/Main.
Insights
Prosthetic valve replacement for aortic stenosis is effective, with low operative mortality even in elderly patients. Early intervention improves outcomes, especially for those with advanced disease.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Geriatric Cardiology
Context:
- Aortic valve stenosis is a significant cause of morbidity and mortality.
- Prosthetic valve replacement has become the standard treatment for symptomatic severe aortic stenosis.
- Outcomes in elderly patients undergoing this procedure require careful evaluation.
Purpose:
- To evaluate the operative mortality and outcomes of prosthetic valve implantation in patients with aortic valve stenosis.
- To assess the impact of age and New York Heart Association (NYHA) functional classification on operative mortality.
- To determine the long-term efficacy of valve replacement in this patient cohort.
Summary:
- Retrospective analysis of 149 patients (mean age 64 years) who underwent prosthetic valve implantation for aortic valve stenosis between 1986 and 1988.
- Overall operative mortality was 3.4%, with a 1-year mortality of 4.7%.
- Higher operative mortality was observed in patients aged 75-86 years (10.3%) compared to younger patients (1.7%). Patients in NYHA grade IV had a 15.8% operative mortality if aged 75-86, versus 4.0% if younger than 75.
Impact:
- Prosthetic valve replacement is the preferred treatment for symptomatic aortic stenosis.
- The procedure demonstrates acceptable mortality rates even in elderly patients.
- Early surgical intervention is crucial for improving outcomes in patients with aortic valve stenosis, particularly the elderly.
Abstract:
Data were retrospectively analysed of 149 consecutive patients with aortic valve stenosis (91 males and 58 females; mean age 64 [27-86] years) who had a prosthetic valve implanted between 1986 and 1988. The overall operative mortality rate was 3.4%, the one-year mortality rate was 4.7%. Operative mortality rate for those aged 27-74 years was 1.7% (2 of 120), but 10.3% (3 of 29) for those aged 75 to 86 years (P less than 0.05). None of the patients in clinical grade III (NYHA classification) died within 30 days of the operation. Among those in grade IV the operative mortality rate was 15.8% (3 of 19) for those aged 75-86, but 4.0% (2 of 50) for those aged below 75 years (P less than 0.05). Valve replacement in symptomatic aortic stenosis with a prosthetic valve is today the method of choice. Operative mortality rate is low, even for patients of advanced age, particularly if the operation is done early.