European Heart Journal Advance Access published online on September 1, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi471
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1 Cardiology Department, Bichat Hospital, AP-HP, 46 rue Henri Huchard, 75018 Paris, France
* To whom correspondence should be addressed. Aims To analyse decision-making in elderly patients with severe, symptomatic aortic stenosis (AS). Methods and results In the Euro Heart Survey on valvular heart disease, 216 patients aged A decision not to operate was taken in 72 patients (33%). In multivariable analysis, left ventricular (LV) ejection fraction [OR = 2.27, 95% CI (1.32-3.97) for ejection fraction 30-50, OR = 5.15, 95% CI (1.73-15.35) for ejection fraction Conclusion Surgery was denied in 33% of elderly patients with severe, symptomatic AS. Older age and LV dysfunction were the most striking characteristics of patients who were denied surgery, whereas comorbidity played a less important role.
Received May 6, 2005
Revised July 4, 2005
Accepted August 4, 2005
Clinical research
Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?
2 Epidemiology, Biostatistic, and Clinical Research Department, Bichat Hospital, AP-HP, Paris, France
3 Cardiology Department, Hopital Cardiologique, Lyon, France
4 Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain
5 Cardiology Department, Heart Centre Bad Krozingen, Germany
6 Thoraxcentre, Rotterdam, The Netherlands
Bernard Iung, E-mail: bernard.iung{at}bch.aphp.fr
Abstract 
75 had severe AS (valve area 
0.6 cm2/m2 body surface area or mean gradient 50 mmHg) and angina or New York Heart Association class III or IV. Patient characteristics were analysed according to the decision to operate or not. 30 vs. > 50%, P = 0.003] and age [OR = 1.84, 95% CI (1.18-2.89) for 80-85 years, OR = 3.38, 95% CI (1.38-8.27) for 85 vs. 75-80 years, P = 0.008] were significantly associated with the decision not to operate; however, the Charlson comorbidity index was not [OR = 1.72, 95% CI (0.83-3.50), P = 0.14 for index 2 vs. < 2]. Neurological dysfunction was the only comorbidity significantly linked with the decision not to operate.
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