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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
Conventional aortic valve replacement for elderly patients in the current era
Kentaro Yamane1, Hitoshi Hirose, Benjamin A Youdelman
1Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. kyamane777@yahoo.co.jp
Summary
Conventional aortic valve replacement (AVR) is a durable procedure for elderly patients with aortic stenosis (AS). This study shows reasonably low operative mortality, especially for lower-risk patients or those needing coronary artery bypass grafting (CABG).
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Valvular Heart Disease
Background:
- Increasing life expectancy highlights the need for effective treatments for age-related aortic valve disease.
- Aortic valve disease in the elderly is often undertreated, necessitating updated surgical outcome data.
- Transcatheter valve implantation procedures are rapidly evolving, requiring comparison with conventional surgery.
Purpose of the Study:
- To analyze short- and long-term outcomes of conventional aortic valve replacement (AVR) in patients aged 70 years and older.
- To identify risk factors associated with long-term mortality after AVR in the elderly population.
- To evaluate the durability and safety of AVR in elderly individuals with aortic stenosis (AS).
Main Methods:
- Retrospective analysis of 308 patients aged 70+ undergoing AVR for AS between 1997 and 2010.
- Inclusion of patients aged 80 and older (124 patients) and those with concomitant coronary artery bypass grafting (CABG) (46%).
- Assessment of operative mortality using the Society of Thoracic Surgeons-Predicted Risk of Mortality (STS-PROM) score and survival rates at 1, 5, and 10 years.
Main Results:
- Overall observed operative mortality was 3.9% (expected 4.8%).
- 1, 5, and 10-year survival rates were 88.6%, 71.6%, and 31.8%, respectively.
- Long-term mortality predictors included diabetes, preoperative shock, left ventricular ejection fraction (LVEF) ≤ 40%, NYHA class III/IV, and advanced age.
Conclusions:
- Conventional AVR is a durable procedure for elderly patients with AS.
- Operative mortality is reasonably low, particularly for lower-risk patients and those requiring concomitant CABG.
- Conventional AVR, with or without CABG, remains the established standard of care for elderly patients with AS.
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