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Related Experiment Videos

Aortic valve replacement for octogenarians: are small valves bad?

B Medalion1, B W Lytle, P M McCarthy

  • 1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.

The Annals of Thoracic Surgery
|October 13, 1998
PubMed
Summary

Octogenarians undergoing aortic valve replacement can safely receive smaller valve prostheses. Valve size did not impact survival or cardiac events in this elderly population, addressing concerns for those with small aortic annuli.

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Area of Science:

  • Cardiovascular Surgery
  • Geriatric Cardiology
  • Biomaterials Science

Background:

  • Aging populations increase the number of octogenarians eligible for aortic valve replacement.
  • Octogenarians, especially women, often have small aortic annuli, posing management challenges.
  • Optimal management strategies for small aortic annuli in octogenarian aortic valve replacement remain uncertain.

Purpose of the Study:

  • To evaluate the safety and efficacy of using small aortic valve prostheses in octogenarian patients.
  • To determine if small valve size impacts mortality or cardiovascular events in this demographic.

Main Methods:

  • Retrospective review of 248 octogenarians (mean age 82.6 years) undergoing aortic valve replacement between 1980-1995.
  • Analysis included primary isolated aortic valve replacement (n=99) and combined aortic valve replacement with coronary revascularization (n=149).

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  • Nineteen-millimeter valves were used in 26% of patients; outcomes were compared based on valve size and procedure type.

    • Main Results:

    • In-hospital mortality was 8.9% overall, with no significant difference based on valve size (12.5% for 19-mm vs. 7.7% for larger valves, p=0.24).
    • Long-term survival at 1, 5, and 10 years was 85%, 60%, and 30%, respectively; survival free from cardiovascular events was 80%, 45%, and 21%.
    • Multivariate analysis identified triple-vessel disease and preoperative congestive heart failure as risk factors for mortality; valve size did not affect late survival.

    Conclusions:

    • The implantation of small aortic valve prostheses in octogenarians is not associated with adverse outcomes.
    • Small valve size does not negatively influence early or late mortality or the incidence of cardiac events in this patient group.
    • These findings support the use of appropriately sized valves, even if smaller, in octogenarians with narrow aortic annuli.