title: Is routine use of stentless aortic prostheses justified in an elderly (aged > or =75 years) population?
abstract: OBJECTIVE
  Stentless prostheses in the aortic position produce a superior hemodynamic profile in comparison to that with stented valves. To determine whether routine use of stentless valves in an elderly population is justified, a 10-year retrospective review was performed of a consecutive series of patients aged > or =75 years undergoing stentless aortic valve replacement (AVR).
  
  
  METHODS
  Demographic, operative and mortality data were obtained retrospectively. Survivors were interviewed by telephone according to a defined protocol. Univariate and multivariate analysis was used to identify independent predictors of 30-day and overall medium-term mortality. Definitions and analyses were in accordance with joint STS/AATS guidelines.
  
  
  RESULTS
  A total of 103 patients (57 males, 46 females; mean age 79.8 years; range: 75-91 years) underwent AVR with a either a Toronto stentless porcine valve (size range: 21-29 mm; n = 74) or an aortic homograft (n = 29). Twenty-eight patients (27%) had either urgent/emergency surgery, 12 (11%) underwent redo surgery, and in 54 cases (52%), the preoperative left ventricular function was significantly impaired (ejection fraction <50%). Forty patients (39%) also underwent concomitant coronary artery bypass grafting. The mean cross-clamp and cardiopulmonary bypass times were 105+/-22 min and 144+/-47 min, respectively. The overall 30-day mortality was 11.6% (n = 12). The 30-day mortality for all elective cases was 5.3%, but for isolated elective AVR was only 2.5%. Using a multivariate model, the only independent predictor of 30-day mortality and medium-term overall mortality was increasing age. The mean follow up period was 3.6 years (range: 0.1-9.3 years), and the Kaplan-Meier actuarial five-year survival was 52%. At follow up, 92% of patients were in NYHA functional classes I and II.
  
  
  CONCLUSIONS
  Stentless AVR in elderly patients is associated with excellent functional and survival outcome in the medium term. Furthermore, in elective cases, age alone should not be a deterrent to the routine use of stentless aortic valves.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Ayyaz
authors.initials: A
authors.lastname: Ali
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kumar
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: James
authors.initials: J
authors.lastname: Halstead
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.forename: Ziad
authors.initials: Z
authors.lastname: Ali
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kumar
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Theodorou
authors.forename: John R
authors.initials: JR
authors.lastname: Pepper
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D001026:Coronary Artery Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011474:Prosthesis Design; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous; D018487:Ventricular Dysfunction, Left / Q000601:surgery