[Severe calcified aortic stenosis in patients aged 80 or older. Apropos of 65 cases surgically treated].
From 1981 to 1989, 65 patients over 80 years were submitted to surgery for severe calcific aortic stenosis. Thirteen patients were in NYHA II, 31 in NYHA III, 21 in NYHA IV. Mean valve area was 0.52 +/- 0.14 cm2 and mean aortic valve gradient was 62 +/- 18 mmHg. Left ventricular function was altered (ejection fraction less than 40%) in 33 patients. Six patients had a previous balloon aortic valvuloplasty. Bioprosthesis were used in all 65 patients associated to CABG (in 5) and mitral valve replacement (in 1). One month mortality was 19 cases (29%) due to cardiac failure (in 10) pulmonary (in 7) and neurological (in only 2) complications. Early mortality was nearly significantly correlated to NYHA stage (p = 0.08) and preop renal insufficiency (p = 0.07). It was significantly correlated to function (40% mortality when ejection fraction less than 40%, 16% in others) and to operations on emergency basis (5 deaths over 6). Hospital morbidity was 68%. There were 5 late deaths. Among the 41 long-term survivors (3 mths-7yrs) 29 are in NYHA I, 10 in NYHA II and 2 in NYHA III due to valve failure. The actuarial survival probability is 65% at one year, 50% at 5 years. In summary good long-term results justify to take a high post operative risk in octogenarians. Early surgery before left ventricular impairment improves the survival.
Deleuze
P
P
Service de chirurgie cardiovasculaire, CHU Henri Mondor, Créteil.
Besnainou
F
F
Hillion
M L
ML
Aubry
P
P
Richemond
J
J
Bloch
G
G
Loisance
D
D
Cachera
J P
JP
D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D001705:Bioprosthesis; D002114:Calcinosis; D002404:Catheterization; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000401:mortality; D006801:Humans; D008297:Male; D013318:Stroke Volume
Le rétrécissement aortique calcifié serré de l'octogénaire. A propos de 65 cas opérés.