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Aortic valve replacement in patients over 70 years

L Bergdahl, V O Björk, R Jonasson

    Scandinavian Journal of Thoracic and Cardiovascular Surgery
    |January 1, 1981
    PubMed
    Summary

    Elderly patients (70+) undergoing aortic valve replacement show good outcomes, with no late deaths and significant improvement. Anticoagulant therapy is crucial for preventing complications in this age group.

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    Area of Science:

    • Cardiovascular Surgery
    • Geriatric Medicine
    • Biomedical Engineering

    Background:

    • Aortic valve replacement is a critical procedure for patients with aortic valve disease.
    • Elderly patients present unique challenges for cardiac surgery due to comorbidities and physiological changes.
    • The suitability of prosthetic valves in older populations requires careful consideration of hemodynamic performance and complication rates.

    Purpose of the Study:

    • To evaluate the safety and efficacy of aortic valve replacement in patients aged 70 years and older.
    • To compare the outcomes associated with the standard Björk-Shiley tilting disc valve and the convexo-concave model.
    • To assess the impact of anticoagulant therapy on thromboembolic complications in elderly recipients.

    Main Methods:

    • Retrospective analysis of 27 patients aged 70+ who underwent aortic valve replacement.
    • Implantation of either the Björk-Shiley standard or convexo-concave tilting disc valve.
    • Follow-up for a mean period of 28 months, monitoring mortality, complications, and functional status.

    Main Results:

    • Early mortality rate was 7%, with no further deaths during follow-up.
    • Thromboembolic complications occurred in 2 untreated patients; none in 23 treated with anticoagulants.
    • Sixty-seven percent of elderly patients required smaller prosthesis diameters (21-23 mm) due to narrow aortic roots.
    • All surviving patients, except one requiring re-operation, showed marked postoperative improvement.

    Conclusions:

    • High age is not an absolute contraindication for aortic valve replacement.
    • The convexo-concave Björk-Shiley prosthesis is well-suited for elderly patients, especially those with small aortic roots, due to its favorable flow characteristics.
    • Anticoagulant treatment is essential for preventing thromboembolic events in elderly patients after aortic valve replacement.

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