[Surgical strategy for critical aoritc stenosis with small aortic annulus in the elderly patients].
BACKGROUND
There are an increasing number of elderly patients with critical aortic stenosis. This study was performed to evaluate the surgical outcome of aortic valve surgery for elderly patients with aortic stenosis.


METHODS
Eleven patients aged over 75 years old (mean 79.7 +/- 4.4) underwent aortic valve replacement with stented bioprosthesis from May 2001 to August 2004. All of the patients had a history of congestive heart failure, syncope, or angina pectoris with multiple medical problems including renal dysfunction, diabetes mellitus, cerebral infarction, or coronary artery disease. The New York Heart Association (NYHA) classification ranged II to IV (mean 2.8 +/- 0.7). Their logistic Euro score ranged from 2.56 to 41.61 (mean 8.6 +/- 10.9). The concomitant procedures were annular enlargement in 2 and coronary artery bypass grafting (CABG) in 3 patients.


RESULTS
All patients tolerated these procedures well and were discharged except 1 patient who died from arrhythmia on the postoperative day 14. Postoperative echocardiogram after 3 months showed satisfactory decrease in peak left ventricular-aortic pressure gradient as well as left ventricular mass regression. All surviving patients are in NYHA class I.


CONCLUSIONS
Aortic valve replacement provided satisfactory results for elderly patients. Surgical treatment should be considered even for the elderly patients with critical aortic stenosis under meticulous perioperative management.
Kamisaka
T
T
Department of Second Surgery, University of Fukui Faculty of Medical Sciences, Fukui, Japan.
Uesaka
T
T
Tanaka
K
K
Morioka
K
K
Ree
I
I
Yamada
N
N
Takamori
A
A
Handa
M
M
Tanabe
S
S
Ihaya
A
A
Sasaki
M
M
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male