Aortic Valve Replacement in Patients Aged Over 80 Years
Pp. 224-238 (15)
Wilhelm Peter Mistiaen
The life expectancy in the Western societies has increased steadily. CAVS is
usually occurring at a higher age, therefore its incidence is also rising. However, the
diagnosis of CAVS in elderly is not always easy: the disease might be overlooked
because its symptoms sometimes are not recognized. Moreover, ascertaining the
valvular origin of the symptoms in elderly patients might be a challenge.
If the presence of a symptomatic CAVS has been established in an elderly patient, the
optimal treatment still has to be decided. Age, frailty, co-morbid conditions and LVF all
have played a role in this decision making. It has become clear that there were and still
are different approaches of cardiologists in regard to the referral policy.
Unto recently, about one third of the patients has been denied AVR unjustly. The
EuroSCORE overestimates the postoperative mortality, especially in high risk patients,
and should be used with great caution.
The available postoperative results seem to justify a referral of octogenarians with
symptomatic CAVS for AVR. Hospital and long-term adverse events in these elderly
patients are more frequent, compared to their younger counterparts. There is, however, a
considerable variation in postoperative results, which is probably due to differences in
the baseline characteristics of the patients. This finding applies for patients of all ages,
The study of risk factors has revealed that need for urgent surgery has a dominant effect
on the postoperative results. This factor is more present in elderly, indicating that poor
postoperative results in elderly could be a self fulfilling prophecy. Long-term
postoperative results in octogenarians show that, compared to the general population, a
normal age and gender matched survival might be reached, with an acceptable quality
CABG, co-morbidity, coronary artery disease, EuroSCORE, frailty,
hospital mortality, independent predictors, left ventricular function, long-term
mortality, octogenarians, quality of life, stentless valves.
Artesis University College Antwerp Department of Healthcare Sciences University of Antwerp Belgium