title: Contemporary surgical or percutaneous management of severe aortic stenosis in the elderly.
abstract: 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.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018 Paris, France.
authors.forename: Fleur
authors.initials: F
authors.lastname: Descoutures
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Laurent
authors.initials: L
authors.lastname: Lepage
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Delphine
authors.initials: D
authors.lastname: Détaint
authors.forename: Didier
authors.initials: D
authors.lastname: Tchetche
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.forename: Yves
authors.initials: Y
authors.lastname: Castier
authors.forename: Jean-Pol
authors.initials: JP
authors.lastname: Depoix
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: 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