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Is surgery for aortic stenosis justified in patients over 75 years of age?
S Chocron1, Etievent JPh, F Clement
1Department of Thoracic and Cardiovascolar Surgery, Hôpital Saint-Jacques, Besançon, France.
Insights
Aortic valvular replacement (AVR) for calcified aortic stenosis (CAS) in patients over 75 offers a good quality of survival and life expectancy similar to the general population. Despite higher operative mortality, AVR is justified for elderly patients with CAS.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Valvular Heart Disease
Background:
- The upper age limit for cardiac surgery, particularly for calcified aortic stenosis (CAS), has been progressively extended.
- Elderly patients (over 75 years) with CAS present unique challenges regarding surgical risk and benefit.
Purpose of the Study:
- To evaluate the benefits of aortic valvular replacement (AVR) in patients over 75 years with CAS.
- To assess hospital mortality, long-term survival, and quality of life after AVR in this elderly cohort.
Main Methods:
- Retrospective analysis of 95 patients aged over 75 undergoing AVR for CAS between 1989 and 1992.
- Inclusion of patients with isolated or predominant CAS, with some requiring concomitant coronary bypass grafting.
- Data collection on demographics, preoperative status, surgical procedures, intraoperative variables, and postoperative outcomes.
Main Results:
- Global hospital mortality was 11.5%, with emergency surgery identified as a predictor of in-hospital mortality.
- Long-term follow-up showed a secondary mortality rate similar to the general population of the same age, with poor left ventricular status and diabetes mellitus as late mortality predictors.
- 78.6% of survivors reported excellent quality of life (NYHA class I), being autonomous and free of sequelae.
Conclusions:
- Aortic valvular replacement for calcified aortic stenosis is justified in patients over 75 years, despite a higher operative mortality compared to younger patients.
- The procedure offers a good quality of survival and a life expectancy comparable to the general population for this age group.
- Careful patient selection is crucial, considering factors like left ventricular function and comorbidities such as diabetes mellitus.
Unlabelled:
The upper age limit for cardiac surgery has constantly been extended since the 1980's, with the most pronounced extension observed in surgery of the calcified aortic stenosis (CAS). The aim of this study was to examine whether surgery is beneficial to the elderly population in terms of hospital mortality, long-term survival and quality of life. Between January 1989 and October 1992, 95 patients over 75 years of age underwent aortic valvular replacement (AVR) for CAS. There were 54 male and 41 female patients with a mean age of 79.7 +/- 2.8 years. All of them suffered from isolated or predominant CAS, associated with a coronary lesion requiring additional bypass procedures in 14 cases. Before surgery 67% of the patients were in NYHA class III and IV and 30% of them had suffered from acute pulmonary edema. Surgical priority was urgent in 10 patients. Mean aortic clamp time was of 55 minutes for the isolated CAS and 78 minutes for the bypass-associated CAS. A Carpentier-Edwards supra-annular bioprosthesis was implanted in 95.7% of the cases, associated with coronary bypass in 14 cases, with a mean of 1.6 bypasses per patient. Global hospital mortality was 11.5%. Emergency surgery was a predictive factor of in hospital mortality in multivariate analysis. Among the 84 survivors, 12 died secondarily, 4 of them due to cardiac causes during the follow-up period (26 +/- 4 months); similar to the mortality rate of the global population for the same age. The factors responsible for this late mortality in multivariate analysis were poor left ventricular status and diabetes mellitus. Survivor's quality of life is excellent with 78.6% of patients termed class I, autonomous and free of sequelae.
In Conclusion:
despite an operative mortality rate much higher than in patients under 70, AVR for CAS is justified even in patients over 75 years as it offers a good quality of survival and a life expectancy identical to that of the general population of the same age.