European Heart Journal Advance Access published online on March 6, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn081
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Contemporary surgical or percutaneous management of severe aortic stenosis in the elderly
1 Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Bichat–Claude Bernard Hospital, 46 rue Henri Huchard, 75018 Paris, France
2 Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Thoracic and Vascular Surgery, Bichat–Claude Bernard Hospital, Paris, France
3 Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Anaesthesiology, Bichat–Claude Bernard Hospital, Paris, France
4 Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiovascular Surgery, Bichat–Claude Bernard Hospital, Paris, France
Received 8 December 2007; revised 28 January 2008; accepted 8 February 2008.
* Corresponding author. Tel: +33 1 40 25 66 01, Fax: +33 1 40 25 88 65, Email: dominique.himbert{at}bch.aphp.fr
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.
Key Words: Aortic stenosis • Valve replacement • Percutaneous valve implantation • Risk evaluation • Elderly
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