Contemporary surgical or percutaneous management of severe aortic stenosis in the elderly

• Published in: European heart journal 2008-06, Vol.29 (11), p.1410-1417
• Main Authors: Descoutures, Fleur, Himbert, Dominique, Lepage, Laurent, Iung, Bernard, Détaint, Delphine, Tchetche, Didier, Brochet, Eric, Castier, Yves, Depoix, Jean-Pol, Nataf, Patrick, Vahanian, Alec
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic stenosis; Aortic Valve - surgery; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Bioprosthesis; Catheterization - methods; Elderly; Epidemiologic Methods; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Male; Percutaneous valve implantation; Risk evaluation; Treatment Outcome; Valve replacement
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehn081

Aims To assess patient characteristics, therapeutic options, and their results in patients referred to a tertiary centre with on-site capabilities for surgical and percutaneous valvular interventions for the management of severe symptomatic aortic stenosis (AS). Methods and results Sixty-six consecutive patients >70 years (83 ± 6 years) were referred for severe AS. Their mortality risk predicted by the logistic European System for Cardiac Operative Risk Evaluation and the Society of Thoracic Surgeons-Predicted Risk of Mortality scores were on average 20 ± 14% and 17 ± 7%, respectively. Thirty-nine patients (59%) were considered at high-risk for surgery or inoperable after multidisciplinary evaluation: 12 (31%) underwent a transfemoral aortic valve implantation and 27 were considered unsuitable and treated medically (n = 16) or with valvuloplasty (n = 7), or were re-directed towards surgery (n = 4). The 27 other patients underwent valve replacement. In-hospital mortality was 9% (6 of 66). There were three hospital deaths in patients treated percutaneously, two in those treated medically, and one after surgery. At 6 months, 10% (6 of 60) of the survivors died: two after valvuloplasty and four after medical treatment. Conclusion A large proportion of elderly patients referred for management of severe AS have a high-risk profile. The availability of percutaneous valvular interventions increases the number of those who are offered interventions.