Related Experiment Videos
[Aortic valve replacement in patients over 70: a Doppler echocardiographic study]
G Sarasso1, L Airoldi, C Piccinino
1Cattedra Clinicizzata di Cardiologia, Università degli Studi di Torino, Sede di Novara.
Cardiologia (Rome, Italy)
|January 29, 1999
Summary
Aortic valve replacement is safe for elderly patients, with smaller prostheses showing higher gradients but similar function. Significant reduction in left ventricular hypertrophy and improved function occur if transvalvular gradients are halved.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Biomedical Engineering
Background:
- Aortic valve disease is the most common valvular issue in the elderly.
- Aortic valve replacement (AVR) is a key therapeutic strategy for this demographic.
- Optimal prosthetic hemodynamic performance is crucial for elderly patients' quality of life, especially with small aortic ostia requiring smaller prostheses.
Purpose of the Study:
- To assess the echocardiographic performance of aortic prosthetic heart valves in elderly patients (>= 70 years).
- To compare AVR outcomes based on prosthesis type and size.
- To evaluate postoperative changes in left ventricular hypertrophy and function in patients with isolated or prevalent aortic stenosis.
Main Methods:
- Retrospective analysis of 151 elderly patients undergoing AVR.
- Echocardiographic assessment of transprosthetic gradients and functional prosthetic area (FPA).
- Comparison of outcomes between mechanical vs. biological prostheses and among three prosthetic size groups (<23mm, 23mm, >23mm).
Main Results:
- Overall mortality was 9.3%. Postoperative transprosthetic gradients and FPA varied significantly with prosthetic size (smaller prostheses had higher gradients).
- No significant differences in performance were observed between mechanical and biological prostheses.
- In patients with isolated/prevalent aortic stenosis, significant reductions in interventricular septal thickness, posterior wall thickness, and left ventricular mass were observed postoperatively. Improvement in left ventricular diameters and function (fractional shortening) was noted in 79% of patients achieving at least a 50% transvalvular gradient reduction.
Conclusions:
- Aortic valve replacement is a safe and effective strategy for the elderly population.
- While smaller prostheses exhibit higher transvalvular gradients, overall left ventricular function remains comparable across different sizes.
- Significant regression of left ventricular hypertrophy and improved myocardial contractility can be expected post-AVR, particularly when a substantial reduction in transvalvular gradient is achieved.