Octogenarians with aortic stenosis. Outcome after aortic valve replacement

Area of Science:

• Cardiology
• Cardiac Surgery
• Geriatric Medicine

Background:

• Aortic stenosis is a common valvular heart disease in the elderly.
• Octogenarians with severe aortic stenosis often present significant surgical risks.
• Evaluating the outcomes of aortic valve replacement (AVR) in this population is crucial for clinical decision-making.

Purpose of the Study:

• To assess the short- and long-term outcomes of aortic valve replacement (AVR) for aortic stenosis in octogenarian patients.
• To identify factors influencing outcomes in this elderly cohort.

Main Methods:

• Retrospective study of 64 patients aged 80-89 years undergoing AVR for aortic stenosis between 1974 and 1987.
• Analysis of in-hospital and late follow-up data, including mortality, complications, and survival rates.
• Stratification of outcomes into uncomplicated, complicated but good results, and unfavorable categories.

Main Results:

• In-hospital mortality was 9.4%.
• 44% of patients had uncomplicated outcomes, 38% had complicated but good outcomes, and 19% had unfavorable outcomes.
• Concomitant coronary artery bypass grafting or mitral valve procedures were associated with a higher rate of unfavorable outcomes (30% vs 6%, p=0.02).
• Actuarial 1- and 5-year survival rates were 83% and 67%, respectively.
• Survivors were largely free of cardiac symptoms.

Conclusions:

• Aortic valve replacement for aortic stenosis in octogenarians, particularly those without severe comorbidities, yields generally favorable short- and long-term results.
• Careful patient selection and consideration of concomitant procedures are important.
• The procedure can be beneficial even in the presence of preoperative left ventricular systolic dysfunction.