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. 1994 May;71(5):449–453. doi: 10.1136/hrt.71.5.449

Aortic valve replacement in elderly patients with aortic stenosis.

E Straumann 1, W Kiowski 1, I Langer 1, E Grädel 1, P Stulz 1, D Burckhardt 1, M Pfisterer 1, F Burkart 1
PMCID: PMC483722  PMID: 8011409

Abstract

OBJECTIVE--To assess the risk of aortic valve replacement and long-term follow-up in elderly patients with dominant aortic stenosis. DESIGN--Retrospective analysis of patients who had aortic valve replacement over a 10 year period and were routinely seen in an outpatient clinic. SETTING--University hospital. PATIENTS--93 patients aged > or = 60 and 47 patients > or = 70 years with symptomatic aortic stenosis undergoing aortic valve replacement. MAIN OUTCOME MEASURES--Early and late mortality in different age groups. Influence of preoperative signs and symptoms on overall outcome. RESULTS--The proportion of patients older than 70 years increased from 11% in 1978 to 54% in 1986. Perioperative mortality was 3.6% and mortality after 2 and 5 years was 9% and 13% respectively. Survival was similar (85% and 83%, respectively) in patients aged 60-69 years (group 1, n = 93, mean age 64.5 (2.7) and patients aged > or = 70 years (group 2, n = 47, mean age 72.6 (2.5)). Additional coronary artery disease and coronary bypass grafting did not significantly affect survival. The cardiothoracic ratio was inversely related to survival (Cox regression, p < 0.05). Preoperative symptoms (syncope, angina pectoris, and dyspnoea) were similar in both patient groups. After a mean (SD) follow up of 51 (33) months 96% of surviving patients were in NYHA functional class I or II with no difference between the two age groups. Similarly, the cardiothoracic ratio and Sokolow index decreased to near normal values in both age groups. CONCLUSION--The risk of aortic valve replacement in patients with dominant aortic stenosis is low and not significantly influenced by age. Therefore replacement may be performed without increased risk in elderly patients and with a good long-term outcome.

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Selected References

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  1. Ahmad A., Starr A. Valve replacement in geriatric patients. Br Heart J. 1969 May;31(3):322–326. doi: 10.1136/hrt.31.3.322. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Austen W. G., DeSanctis R. W., Buckley M. J., Mundth E. D., Scannell J. G. Surgical management of aortic valve disease in the elderly. JAMA. 1970 Jan 26;211(4):624–626. [PubMed] [Google Scholar]
  3. Barnhorst D. A., Giuliani E. R., Pluth J. R., Danielson G. K., Wallace R. B., McGoon D. C. Open-heart surgery in patients more than 65 years old. Ann Thorac Surg. 1974 Jul;18(1):81–90. doi: 10.1016/s0003-4975(10)65721-9. [DOI] [PubMed] [Google Scholar]
  4. Bessone L. N., Pupello D. F., Hiro S. P., Lopez-Cuenca E., Glatterer M. S., Jr, Ebra G. Surgical management of aortic valve disease in the elderly: a longitudinal analysis. Ann Thorac Surg. 1988 Sep;46(3):264–269. doi: 10.1016/s0003-4975(10)65923-1. [DOI] [PubMed] [Google Scholar]
  5. Bowles L. T., Hallman G. L., Cooley D. A. Open-heart surgery in patients over sixty years of age. J Am Geriatr Soc. 1969 Sep;17(9):817–821. doi: 10.1111/j.1532-5415.1969.tb02359.x. [DOI] [PubMed] [Google Scholar]
  6. Bruce R. A. Editorial: Values and limitations of exercise electrocardiography. Circulation. 1974 Jul;50(1):1–3. doi: 10.1161/01.cir.50.1.1. [DOI] [PubMed] [Google Scholar]
  7. Cabrol C., Bensaid J., Doumeix J. J., Blanc G., Acar J., Morin B. Risques et résultats à moyen terme du remplacement valvulaire aortique pour sténose calcifiée chez 100 sujets de plus de 70 ans. Arch Mal Coeur Vaiss. 1979 Aug;72(8):842–848. [PubMed] [Google Scholar]
  8. Carabello B. A., Green L. H., Grossman W., Cohn L. H., Koster J. K., Collins J. J., Jr Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation. 1980 Jul;62(1):42–48. doi: 10.1161/01.cir.62.1.42. [DOI] [PubMed] [Google Scholar]
  9. Carabello B. A., Williams H., Gash A. K., Kent R., Belber D., Maurer A., Siegel J., Blasius K., Spann J. F. Hemodynamic predictors of outcome in patients undergoing valve replacement. Circulation. 1986 Dec;74(6):1309–1316. doi: 10.1161/01.cir.74.6.1309. [DOI] [PubMed] [Google Scholar]
  10. Cohn L. H. The long-term results of aortic valve replacement. Chest. 1984 Mar;85(3):387–396. doi: 10.1378/chest.85.3.387. [DOI] [PubMed] [Google Scholar]
  11. Copeland J. G., Griepp R. B., Stinson E. B., Shumway N. E. Isolated aortic valve replacement in patients older than 65 years. JAMA. 1977 Apr 11;237(15):1578–1581. [PubMed] [Google Scholar]
  12. Culliford A. T., Galloway A. C., Colvin S. B., Grossi E. A., Baumann F. G., Esposito R., Ribakove G. H., Spencer F. C. Aortic valve replacement for aortic stenosis in persons aged 80 years and over. Am J Cardiol. 1991 Jun 1;67(15):1256–1260. doi: 10.1016/0002-9149(91)90937-g. [DOI] [PubMed] [Google Scholar]
  13. Dalichau H., Hannekum A., Lie T. B. Herzklappenersatzchirurgie im höheren Lebensalter. Lebensversicher Med. 1982 Jan;34(1):9–12. [PubMed] [Google Scholar]
  14. Di Lello F., Flemma R. J., Anderson A. J., Mullen D. C., Kleinman L. H., Werner P. H. Improved early results after aortic valve replacement: analysis by surgical time frame. Ann Thorac Surg. 1989 Jan;47(1):51–56. doi: 10.1016/0003-4975(89)90232-4. [DOI] [PubMed] [Google Scholar]
  15. Edmunds L. H., Jr, Stephenson L. W., Edie R. N., Ratcliffe M. B. Open-heart surgery in octogenarians. N Engl J Med. 1988 Jul 21;319(3):131–136. doi: 10.1056/NEJM198807213190302. [DOI] [PubMed] [Google Scholar]
  16. Glock Y., Pecoul R., Cerene A., Laguerre J., Puel P. Aortic valve replacement in elderly patients. J Cardiovasc Surg (Torino) 1984 May-Jun;25(3):205–210. [PubMed] [Google Scholar]
  17. Guthrie R. B., Spellberg R. D., Benedict J. S., Buhl T. L. Open-heart valve surgery in patients 65 and older. Arch Surg. 1972 Jul;105(1):42–43. doi: 10.1001/archsurg.1972.04180070040007. [DOI] [PubMed] [Google Scholar]
  18. Hancock E. W. Timing of valve replacement for aortic stenosis. Circulation. 1990 Jul;82(1):310–312. doi: 10.1161/01.cir.82.1.310. [DOI] [PubMed] [Google Scholar]
  19. Hoffmann A., Vogt S., Roth J., Grädel E., Althaus U., Goy J. J., Sadeghi H., Burckhardt D. Herzklappensersatz: der Einfluss präoperativer Befunde auf das Spätresultat. Schweiz Med Wochenschr. 1992 Dec 12;122(50):1907–1910. [PubMed] [Google Scholar]
  20. Jegaden O., Devolfe C., Coll J., Adeleine P., Beaune J., Delaye J., Mikaeloff P. Remplacement valvulaire aortique isolé à un stade évolué d'insuffisance cardiaque. Résultats et étude pronostique à propos de 71 cas. Arch Mal Coeur Vaiss. 1986 Jan;79(1):95–102. [PubMed] [Google Scholar]
  21. Krayenbuehl H. P., Hess O. M., Monrad E. S., Schneider J., Mall G., Turina M. Left ventricular myocardial structure in aortic valve disease before, intermediate, and late after aortic valve replacement. Circulation. 1989 Apr;79(4):744–755. doi: 10.1161/01.cir.79.4.744. [DOI] [PubMed] [Google Scholar]
  22. Krayenbühl H. P., Hess O. M., Schneider J., Turina M. Regression der Myokardhypertrophie bei Aortenvitien nach Aortenklappenersatz. Schweiz Med Wochenschr. 1988 Apr 9;118(14):517–521. [PubMed] [Google Scholar]
  23. Kuntz R. E., Tosteson A. N., Berman A. D., Goldman L., Gordon P. C., Leonard B. M., McKay R. G., Diver D. J., Safian R. D. Predictors of event-free survival after balloon aortic valvuloplasty. N Engl J Med. 1991 Jul 4;325(1):17–23. doi: 10.1056/NEJM199107043250104. [DOI] [PubMed] [Google Scholar]
  24. Lombard J. T., Selzer A. Valvular aortic stenosis. A clinical and hemodynamic profile of patients. Ann Intern Med. 1987 Feb;106(2):292–298. doi: 10.7326/0003-4819-106-2-292. [DOI] [PubMed] [Google Scholar]
  25. Lund O. Preoperative risk evaluation and stratification of long-term survival after valve replacement for aortic stenosis. Reasons for earlier operative intervention. Circulation. 1990 Jul;82(1):124–139. doi: 10.1161/01.cir.82.1.124. [DOI] [PubMed] [Google Scholar]
  26. Lund O., Vaeth M. Prediction of late results following valve replacement in aortic valve stenosis. Seventeen years of follow-up examined with the Cox regression analysis. Thorac Cardiovasc Surg. 1987 Oct;35(5):295–303. doi: 10.1055/s-2007-1020250. [DOI] [PubMed] [Google Scholar]
  27. Otto C. M., Pearlman A. S., Gardner C. L. Hemodynamic progression of aortic stenosis in adults assessed by Doppler echocardiography. J Am Coll Cardiol. 1989 Mar 1;13(3):545–550. doi: 10.1016/0735-1097(89)90590-1. [DOI] [PubMed] [Google Scholar]
  28. Pellegrini A., Marcazzan E., Peronace B., De Gasperis C., Gordini V., Mombelloni G. Ten years' experience in heart valve replacement with artificial prostheses: immediate and long-term results in 1812 cases. J Cardiovasc Surg (Torino) 1975 Nov-Dec;16(6):612–625. [PubMed] [Google Scholar]
  29. Pfulg M., Turina M., Senning A. Der Aortenklappenersatz beim älteren Patienten. Schweiz Med Wochenschr. 1982 May 1;112(18):634–638. [PubMed] [Google Scholar]
  30. Richardson J. V., Kouchoukos N. T., Wright J. O., 3rd, Karp R. B. Combined aortic valve replacement and myocardial revascularization: results in 220 patients. Circulation. 1979 Jan;59(1):75–81. doi: 10.1161/01.cir.59.1.75. [DOI] [PubMed] [Google Scholar]
  31. Roger V. L., Tajik A. J., Bailey K. R., Oh J. K., Taylor C. L., Seward J. B. Progression of aortic stenosis in adults: new appraisal using Doppler echocardiography. Am Heart J. 1990 Feb;119(2 Pt 1):331–338. doi: 10.1016/s0002-8703(05)80024-9. [DOI] [PubMed] [Google Scholar]
  32. Schuster P., Trieb G., Sturm A. Zur Problematik von Diagnostik und Therapie erworbener Herzklappenfehler bei Patienten in höherem Lebensalter. Z Gerontol. 1985 Sep-Oct;18(5):305–312. [PubMed] [Google Scholar]
  33. Sechtem U., Müller-Haake R. C. Coronary artery disease in aortic stenosis. Z Kardiol. 1986;75 (Suppl 2):86–89. [PubMed] [Google Scholar]
  34. Selzer A. Changing aspects of the natural history of valvular aortic stenosis. N Engl J Med. 1987 Jul 9;317(2):91–98. doi: 10.1056/NEJM198707093170206. [DOI] [PubMed] [Google Scholar]
  35. Sethi G. K. Should aortic valve replacement be performed in elderly patients? Ann Thorac Surg. 1988 Sep;46(3):262–263. doi: 10.1016/s0003-4975(10)65922-x. [DOI] [PubMed] [Google Scholar]
  36. Vanetti A., Donzeau-Gouge G. P., Peres S., Daumet P. Remplacement valvulaire aortique chez 34 opérés de plus de 70 ans. Arch Mal Coeur Vaiss. 1980 Sep;73(9):1103–1109. [PubMed] [Google Scholar]
  37. Wisoff B. G., Fogel R., Weisz D., Garvey J., Hamby R. Combined valve and coronary artery surgery. Ann Thorac Surg. 1980 May;29(5):440–443. doi: 10.1016/s0003-4975(10)61675-x. [DOI] [PubMed] [Google Scholar]

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