title: Aortic valve replacement in the elderly: the real life.
abstract: BACKGROUND
  Aortic stenosis is of concern in the elderly. Although aortic valve replacement provides good long-term survival with functional improvement, many elderly patients are still not referred for surgery because of their age. Percutaneous aortic valve implantation offers an alternative to open-heart surgery. Concerns about the management of aortic valve stenosis in the elderly will be reviewed.
  
  
  METHODS
  We retrospectively analyzed 1,193 consecutive aortic valve replacements, performed in octogenarians since January 2000. A total of 657 patients (55%) had at least one associated comorbidity (eg, respiratory failure) and 381 (32%) associated coronary lesions. Valve replacement was the only procedure in 883 patients (74%), and was associated with coronary revascularization in 262 cases, or with another cardiac procedure in 48 patients.
  
  
  RESULTS
  Overall operative mortality was 6.9% (83 of 1,193 patients); 5.5% for single replacement and 11.5% if associated with coronary artery bypass surgery. Univariate and multivariate analyses identified 11 operative risk factors related to general status, cardiologic condition, and the procedure itself: older age (p<0.015); respiratory failure (p<0.03); aortic regurgitation (p<0.001); emergency surgery (p<0.0029); New York Heart Association class IV (p<0.0007); right heart failure (p<0.03); atrial fibrillation (p<0.04); impaired ejection fraction (p<0.001); coronary disease (p<0.01); redo surgery (p<0.02); associated coronary revascularization (p<0.008).
  
  
  CONCLUSIONS
  Today, valve replacement has acceptable low hospital mortality, even in the elderly. Thus, older patients should not be denied surgery due to their advanced age alone. Conventional surgery remains the gold standard treatment for aortic stenosis; the decision should be made on an individual basis. If several risk factors suggest very high-risk surgery, then percutaneous valve implantation should be considered instead.
authors: Department of Cardiovascular and Thoracic Surgery, University Hospital, Rennes, France. thierry.langanay@chu-rennes.fr
authors: Thierry
authors: T
authors: Langanay
authors: Erwan
authors: E
authors: Flécher
authors: Olivier
authors: O
authors: Fouquet
authors: Vito Giovanni
authors: VG
authors: Ruggieri
authors: Bertrand
authors: B
authors: De La Tour
authors: Christian
authors: C
authors: Félix
authors: Bernard
authors: B
authors: Lelong
authors: Jean-Philippe
authors: JP
authors: Verhoye
authors: Hervé
authors: H
authors: Corbineau
authors: Alain
authors: A
authors: Leguerrier
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome