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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
Contemporary strategy for aortic valve stenosis in octogenarians
Hiroyuki Tsukui1, Kenji Yamazaki
1Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada Shinjuku, Tokyo, 162-8666, Japan, htsukui@wf7.so-net.ne.jp.
Surgery Today
|July 16, 2013
Summary
Aortic stenosis (AS) affects more elderly patients, with transcatheter aortic valve replacement (TAVR) offering an alternative to surgery. TAVR shows comparable survival rates to standard aortic valve replacement (AVR) in octogenarians, despite some increased risks.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Geriatric Medicine
Background:
- Increasing prevalence of aortic stenosis (AS) due to longer life expectancy.
- Many elderly patients with severe AS are denied standard surgery due to comorbidities.
- Standard aortic valve replacement (AVR) demonstrates excellent outcomes in octogenarians.
Purpose of the Study:
- To evaluate transcatheter aortic valve replacement (TAVR) as an alternative therapy for severe aortic stenosis.
- To compare outcomes of TAVR versus standard AVR in elderly patients, particularly octogenarians.
- To assess the safety and efficacy of TAVR, including associated complications.
Main Methods:
- Review of recent data on standard AVR outcomes in octogenarians.
- Analysis of outcomes from the Placement of Aortic Transcatheter Valves (PARTNER) trial.
- Comparison of mortality rates, stroke incidence, and vascular complications between TAVR and AVR groups.
Main Results:
- Standard AVR in octogenarians shows low early mortality (2.4-6.8%) and survival comparable to the general population.
- TAVR demonstrated acceptable early outcomes with similar 1- and 2-year mortality rates compared to AVR.
- TAVR group had a higher stroke rate (3.4% vs. 1.9%), with vascular complications and paravalvular leakage being key concerns.
Conclusions:
- Transcatheter aortic valve replacement (TAVR) is a viable alternative for elderly patients with severe aortic stenosis unsuitable for standard AVR.
- While TAVR offers comparable survival, careful management of procedural complications like vascular issues and leakage is crucial for improved outcomes.
- Continued research and technological advancements in TAVR are essential for optimizing patient care in aortic stenosis management.
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