Management of the elderly patient with aortic stenosis

Heart

Volumn 94, Issue 4, 2008, Pages 519-524

  Iung, Bernard ^a  

^a BICHAT HOSPITAL   (France)

Author keywords

[No Author keywords available]

Indexed keywords

ANGIOCARDIOGRAPHY; AORTA STENOSIS; AORTIC VALVE REPAIR; BIOPROSTHESIS; CARDIOVASCULAR RISK; CORONARY ARTERY BYPASS GRAFT; HEART ATRIUM FIBRILLATION; HEART CATHETERIZATION; HUMAN; LIFE EXPECTANCY; MEDICAL DECISION MAKING; MORTALITY; OUTCOME ASSESSMENT; PRIORITY JOURNAL; REVIEW; SURVIVAL RATE;

AGE FACTORS; AGED; AGED, 80 AND OVER; AORTIC VALVE STENOSIS; BALLOON DILATATION; HEART VALVE PROSTHESIS IMPLANTATION; HUMANS; MIDDLE AGED; PROGNOSIS; TREATMENT OUTCOME;

EID: 41149106902     PISSN: 13556037     EISSN: None     Source Type: Journal    
DOI: 10.1136/hrt.2007.122804     Document Type: Review

References (20)

1. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur Heart J 2003;24:1231-43. ▶ A contemporary assessment of the presentation and actual practices in the management of patients with valvular heart disease in 25 European countries.
2. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet 2006;368:1005-11. ▶ The first estimation of the prevalence of heart valve diseases in the general population, showing a sharp increase in the prevalence of aortic stenosis after the age of 65 years.
3. Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol 2006;48:e1-148.
4. Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease. Eur Heart J 2007;28:230-68. ▶ The two recent guidelines review the rationale for interventions in valvular heart disease. It is clearly stated that age in itself is not a contraindication to aortic valve replacement.
5. Bouma BJ, van den Brink RBA, van der Meulen JHP, et al. To operate or not elderly patients with aortic stenosis: the decision and its conseguences. Heart 1999;82:143-8. ▶ A contemporary series improving the knowledge of the natural history of severe aortic stenosis. It shows in particular the strong negative impact of severe symptoms and left ventricular dysfunction on survival of non-operated patients.
6. Rajamannan NM, Gersh B, Bonow RO. Calcific aortic stenosis: from bench to the bedside. Emerging clinical and cellular concepts. Heart 2003;89:801-5.
7. Lee SJ, Lindquist K, Segal MR, et al. Development and validation of a prognostic index for 4-year mortality in older adults. JAMA 2006;295:801-8. ▶ A multivariate score based on a self questionnaire estimating life expectancy in the elderly according to age and comorbidities.
8. Iung B. Interface between valve disease and ischaemic heart disease. Heart 2000;84:347-52.
9. Logeais Y, Langanay T, Roussin R, et al. Surgery for aortic stenosis in elderly patients. A study of surgical risk and predictive factors. Circulation 1994;90:2891-8. ▶ This large series led to the first simulation of operative mortality following aortic valve replacement in the elderly, pointing out the variability of operative risk according to patient characteristics.
10. Roques F, Nashef SAM, Michel P, and the Euroscore study group. Risk factors for early mortality after valve surgery in Europe in the 1990s: lessons from the Euroscore pilot program. J Heart Valve Dis 2001;10:572-8.
11. Iung B, Baron G, Fondard O, et al. Is the Euroscore valid to predict operative mortality for valve surgery? J Am Coll Cardiol 2005;45(suppl A):357A.
12. Edwards FH, Peterson ED, Coombs LP, et al. Prediction of operative mortality after valve replacement surgery. J Am Coll Cardiol 2001;37:885-92.
13. Jin R, Grunkemeier GL, Starr A, et al. Validation and refinement of mortality risk models for heart valve surgery. Ann Thorac Surg 2005;80:471-9.
14. Ambler G, Omar RZ, Royston P, et al. Generic, simple risk stratification model for heart valve surgery. Circulation 2005;112:224-31. ▶ This paper describes a user-friendly multivariate score predicting operative mortality, which was specifically elaborated and validated in patients with valvular heart disease.
15. Collart F, Feier H, Kerbaul F, et al. Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long-term results. Eur J Cardiothorac Surg 2005;27:276-80.
16. Gogbashian A, Sedrakyan A, Treasure T. EuroSCORE: a systematic review of international performance. Eur J Cardiothorac Surg 2004;25:695-700.
17. Kvidal P, Bergström R, Hörte LG, et al. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol 2000;35:747-56. ▶ This analysis of relative survival illustrates the importance of comparing observed survival to the expected outcome in sex- and age-matched populations.
18. Webb JG, Pasupati S, Humphries K, et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation 2007;116:755-63.
19. Walther T, Falk V, Borger MA, et al. Minimally invasive transapical beating heart aortic valve implantation proof of concept. Eur J Cardiothorac Surg 2007;31:9-15.
20. Iung B, Cachier A, Baron G, et al. Decision making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 2005;26:2714-20. ▶ This European survey shows that a third of patients aged over 75 years with severe symptomatic aortic stenosis are denied surgery and that the factors associated with a decision not to operate are not in accordance with guidelines.