Conventional aortic valve replacement in 2005 elderly patients: a 32-year experience

Area of Science:

• Cardiology
• Cardiac Surgery
• Geriatric Medicine

Background:

• Transcatheter aortic valve implantation (TAVI) has raised questions about conventional aortic valve replacement (AVR) in high-risk and elderly patients.
• Conventional AVR remains a primary treatment option for aortic stenosis, necessitating evaluation of its long-term efficacy in older populations.

Purpose of the Study:

• To evaluate the long-term outcomes of conventional AVR in patients aged 80 years and older.
• To assess survival rates, causes of death, and quality of life following AVR in octogenarians.

Main Methods:

• A retrospective analysis of 2005 patients aged ≥80 years who underwent AVR between 1978 and 2011.
• Data collection included patient demographics, comorbidities, surgical procedures, and long-term follow-up via questionnaires and telephone contact.

Main Results:

• Early mortality for isolated AVR was 5.5% in the last decade of the study.
• Long-term follow-up (99.5% complete) showed a median survival of 7.1 years, with 83% survival at 2 years, 62.5% at 5 years, and 25% at 10 years.
• Ninety percent of late survivors reported functional improvement; cardiovascular disease, neurological deficit, and cancer were main late causes of death.

Conclusions:

• Conventional AVR is effective for aortic stenosis across all age groups, including octogenarians.
• Elderly patients should not be denied AVR solely based on age, as it offers an excellent quality of life and restores life expectancy.
• While TAVI is indicated for non-operable or high-risk patients, conventional AVR remains the preferred treatment for most patients with aortic stenosis.