Contemporary surgical or percutaneous management of severe aortic stenosis in the elderly.
OBJECTIVE
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).


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.


CONCLUSIONS
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.
Descoutures
Fleur
F
Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018 Paris, France.
Himbert
Dominique
D
Lepage
Laurent
L
Iung
Bernard
B
Détaint
Delphine
D
Tchetche
Didier
D
Brochet
Eric
E
Castier
Yves
Y
Depoix
Jean-Pol
JP
Nataf
Patrick
P
Vahanian
Alec
A
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D002404:Catheterization / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D016896:Treatment Outcome