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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Aortic valve replacement in the elderly: the real life
Thierry Langanay1, Erwan Flécher, Olivier Fouquet
1Department of Cardiovascular and Thoracic Surgery, University Hospital, Rennes, France. thierry.langanay@chu-rennes.fr
The Annals of Thoracic Surgery
|October 11, 2011
Summary
Aortic valve replacement is a safe and effective treatment for elderly patients with aortic stenosis, offering good survival rates. Advanced age alone should not preclude patients from receiving this life-improving surgery.
Area of Science:
- Cardiology
- Geriatric Medicine
- Cardiac Surgery
Background:
- Aortic stenosis (AS) is a significant concern in the elderly population.
- While aortic valve replacement (AVR) improves survival and function, elderly patients are often excluded due to age.
- Percutaneous aortic valve implantation (TAVI) presents an alternative to traditional open-heart surgery.
Purpose of the Study:
- To review concerns regarding the management of aortic valve stenosis in the elderly.
- To evaluate the outcomes of conventional aortic valve replacement in octogenarians.
- To identify risk factors associated with surgical outcomes in this patient group.
Main Methods:
- Retrospective analysis of 1,193 consecutive aortic valve replacements in octogenarians since January 2000.
- Assessment of comorbidities, including respiratory and cardiac conditions, and coronary lesions.
- Categorization of procedures: isolated AVR, AVR with coronary artery bypass grafting (CABG), or AVR with other cardiac procedures.
Main Results:
- Overall operative mortality was 6.9%, with 5.5% for isolated AVR and 11.5% for AVR with CABG.
- Eleven significant operative risk factors were identified, including older age, respiratory failure, atrial fibrillation, and impaired ejection fraction.
- Comorbidities and the complexity of the procedure, such as associated coronary revascularization, impacted mortality rates.
Conclusions:
- Aortic valve replacement demonstrates acceptable low hospital mortality in the elderly, challenging age-based exclusion criteria.
- Conventional surgery remains the gold standard for AS, with decisions individualized based on risk factors.
- Percutaneous aortic valve implantation should be considered for very high-risk patients identified by multiple risk factors.
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