Interv Akut Kardiol. 2009;8(4):182-185

Surgical treatment of aortic valve disease in the elderly

MUDr. Eva Koudelková CSc

Klinika kardiologie, Institut klinické a experimentální medicíny, Praha

The number of elderly patients undergoing aortic valve surgery is increasing with the increase in life expectancy. The symptoms in septaand

octogenarians are often underestimated due to limited physical activity and they are reffered for surgery too late when advanced

calcifications of aortic valve as well as left ventricular systolic dysfunction in elderly men and diastolic dysfunction of the left ventricle in

elderly women are present. More than half of these patients require concomitant coronary artery bypass grafting and secondary mitral

insufficiency and pulmonary hypertension are also frequent. The prevalence of preoperative co-morbidities is also high of which renal

failure, obstructive pulmonary disease and peripheral vascular disease are especially important predictors of postoperative morbidity

and mortality.

Risk factors of operative mortality include prolonged cardiopulmonary bypass and cross-clamp time with the risk of acute renal or

multiorgan failure postoperatively. The results support a conservative approach to concomitant mitral surgery for secondary mitral

regurgitation in these patients undergoing aortic valve replacement. Additional procedure on aortic anulus and ascending aorta should

also be avoided to reduce ischemic times especially in octogenarians.

Elderly patients benefit from bioprosthetic valves because of avoiding anticoagulation with the associated risk of hemorrhage. However,

in patients with coexisting indications for systemic anticoagulation and in elderly women with severely hypertrophied left ventricle and

narrow aortic annulus mechanical valves are advantageous.

At the present time, aortic valve replacement in septa- and octogenarians has acceptable operative mortality and excellent functional

outcome with satisfactory long-term survival.

Keywords: aortic stenosis, aortic valve replacement, elderly.

Published: September 1, 2009  Show citation