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[Replacement of the aortic valve in patients over 60 years of age]
J Dominik1, J Cerný, J Nicovský
1Výzkumný ústav kardiovaskulární a transplantacní chirurgie, Brno.
Insights
Aortic valve replacement in patients over 60 significantly improves quality of life and survival. Advanced age is not a barrier to cardiac surgery, with bioprostheses recommended to lower complication risks.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
Context:
- Elderly patients often present with severe aortic valve disease requiring intervention.
- Traditional concerns about surgical risk in older adults may limit treatment options.
Purpose:
- To evaluate the safety and efficacy of aortic valve replacement (AVR) in patients aged 60 and above.
- To assess the impact of AVR on functional status and long-term outcomes in this demographic.
Summary:
- A study of 49 patients over 60 undergoing AVR showed a 4.1% early mortality rate.
- Patients undergoing isolated AVR had no mortality; combined procedures had a 12.5% mortality.
- One-year follow-up revealed 92% of patients improved to NYHA functional class I or II, compared to pre-operative class III or IV.
Impact:
- Aortic valve replacement is a viable and beneficial procedure for elderly patients, improving both survival and quality of life.
- Advanced age should not be considered a contraindication for AVR.
- Bioprosthetic valves are recommended for older patients to reduce long-term hemorrhagic complications.
Abstract:
The authors evaluated a group of operated patients above 60 years of age where the main cardiosurgical operation was a aortic valve replacement. The early mortality in the group comprising 49 patients was 4.1%. (Of 33 patients where the replacement of the aortic valve was an isolated operation none of the patients died. From another 16 patients where also the mitral valve had to be replaced or IHD had to be resolved by revascularization of the heart muscle by aortocoronary bypasses, two patients died.) During a check-up examination one year after operation 92% of the checked patients where in functional group I or II according to NYHA classification (before operation all were in group III or IV). Prostheses of aortic valves do not only considerably prolong the life even in older patients but also improve its quality. Advanced age alone is no contraindication for operation and the surgical risk is not greater than in younger age groups. The authors recommend to implant in advanced age bioprostheses because of the markedly lower risk of serious haemorrhagic complications in the long-term postoperative course.