Aortic Valve Replacement in the Elderly: The Real Life

被引:55
作者
Langanay, Thierry
Flecher, Erwan
Fouquet, Olivier
Ruggieri, Vito Giovanni
De La Tour, Bertrand
Felix, Christian
Lelong, Bernard
Verhoye, Jean-Philippe
Corbineau, Herve
Leguerrier, Alain
机构
[1] Univ Hosp, Dept Cardiovasc & Thorac Surg, Rennes, France
[2] Univ Hosp, Dept Anesthesiol, Rennes, France
关键词
AGED; 80; YEARS; CARDIAC-SURGERY; HOSPITAL MORTALITY; OCTOGENARIANS; STENOSIS; OLDER; EUROSCORE; RISK; DISEASE;
D O I
10.1016/j.athoracsur.2011.07.033
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Aortic stenosis is of concern in the elderly. Although aortic valve replacement provides good long-term survival with functional improvement, many elderly patients are still not referred for surgery because of their age. Percutaneous aortic valve implantation offers an alternative to open-heart surgery. Concerns about the management of aortic valve stenosis in the elderly will be reviewed. Methods. We retrospectively analyzed 1,193 consecutive aortic valve replacements, performed in octogenarians since January 2000. A total of 657 patients (55%) had at least one associated comorbidity (eg, respiratory failure) and 381 (32%) associated coronary lesions. Valve replacement was the only procedure in 883 patients (74%), and was associated with coronary revascularization in 262 cases, or with another cardiac procedure in 48 patients. Results. Overall operative mortality was 6.9% (83 of 1,193 patients); 5.5% for single replacement and 11.5% if associated with coronary artery bypass surgery. Univariate and multivariate analyses identified 11 operative risk factors related to general status, cardiologic condition, and the procedure itself: older age (p< 0.015); respiratory failure (p <0.03); aortic regurgitation (p <0.001); emergency surgery (p <0.0029); New York Heart Association class IV (p < 0.0007); right heart failure (p < 0.03); atrial fibrillation (p < 0.04); impaired ejection fraction (p < 0.001); coronary disease (p < 0.01); redo surgery (p < 0.02); associated coronary revascularization (p < 0.008). Conclusions. Today, valve replacement has acceptable low hospital mortality, even in the elderly. Thus, older patients should not be denied surgery due to their advanced age alone. Conventional surgery remains the gold standard treatment for aortic stenosis; the decision should be made on an individual basis. If several risk factors suggest very high-risk surgery, then percutaneous valve implantation should be considered instead. (Ann Thorac Surg 2012;93:70-8) (C) 2012 by The Society of Thoracic Surgeons
引用
收藏
页码:70 / 78
页数:9
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