title: Conventional aortic valve replacement for elderly patients in the current era.
abstract: BACKGROUND
  Because of the rising expectation of prolonged life in the general population and the recent recognition of undertreated aortic valve disease in the elderly, updating the available results of aortic valve surgery is imperative, especially considering the rapid evolution of the transcatheter valve implantation procedure.
  
  
  RESULTS
  Between 1997 and 2010, 308 patients aged 70 years or older underwent aortic valve replacement (AVR) for aortic stenosis (AS). Short- and long-term results were analyzed and risk factors for long-term mortality were determined. Mean age was 78.5 years and 124 patients were aged 80 or older. Concomitant coronary artery bypass grafting (CABG) was performed in 46% of the cases. Mean left ventricular ejection fraction (LVEF) was 52%. Overall observed and expected operative mortality using the Society of Thoracic Surgeons-Predicted Risk of Mortality score was 3.9% and 4.8%, respectively. Overall survival rates at 1, 5, and 10 years were 88.6%, 71.6%, and 31.8%, respectively. Predictors of long-term mortality included diabetes; preoperative shock; LVEF ≤ 40%; New York Heart Association functional class III or IV; and age.
  
  
  CONCLUSIONS
  Short- and long-term results of conventional AVR in the elderly prove it to be durable and, especially in relatively low-risk patients and patients who require concomitant CABG, operative mortality is reasonably low. Conventional AVR ± CABG remains the gold standard for elderly patients with AS.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. kyamane777@yahoo.co.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamane
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirose
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Youdelman
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Bogar
authors.forename: James T
authors.initials: JT
authors.lastname: Diehl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D006299:Health Services for the Aged; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate