Abstract
Senile aortic stenosis (AS) remains the most frequent acquired valve disease in the elderly population and has an estimated prevalence of 4.6% in adults more than 75 years of age. With the increase in geriatric population, it is estimated that the number of patients requiring evaluation for surgical treatment for AS will correspondingly dramatically increase. Conventional open aortic valve replacement utilizing cardiopulmonary bypass (CPB) remains the standard of care with excellent results. Newer innovative valve replacement techniques which do not require CPB (off-pump left ventricular to descending aortic conduits and transcatheter aortic valve implantation) may provide adequate relief of aortic stenosis with reduced morbidity and mortality.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Census US. http://www.census.gov/population/www/projections/index.html. Accessed 20 Oct 2009.
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368:1005–11.
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.
Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Silvary G, Adams DH. Excellent early and late outcomes of aortic valve replacement in people aged 80 and older. J Am Geriatr Soc. 2008;56:255–61.
Thourani VH, Myung R, Kilgo P, et al. Long-term outcomes after isolated aortic valve replacement in octogenarians: a modern prospective. Ann Thorac Surg. 2008;86:1458–65.
Sundt TM, Bailey MS, Moon MR, et al. Quality of life after aortic valve replacement at the age of > 80 years. Circulation. 2000;102:III-70–4.
Chukwuemeka A, Borger MA, Ivanov J, Armstrong S, Feindel CM, David TE. Valve surgery in octogenarians: a safe option with good medium-term results. J Heart Valve Dis. 2006;15:191–6.
Stoica SC, Cafferty F, Kitcat J, et al. Octogenarians undergoing cardiac surgery outlive their peers: a case for early referral. Heart. 2006;92:503–6.
Kohl P, Kerzmann A, Lahaye L, Gerard P, Limet R. Cardiac surgery in octogenarians: peri-operative outcome and long-term results. Eur Heart J. 2001;22:1235–43.
Varadarajan P, Kapoor N, Bansal RC, Pai RG. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann Thorac Surg. 2006;82:2111–5.
Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52:e1–142.
Bramstedt KA. Aortic valve replacement in the elderly: frequently indicated yet frequently denied. Gerontology. 2003;49:46–9.
Asimakopoulos F, Edwards MB, Taylor KM. Aortic valve replacement in patients 80 years of age and older: survival and cause of death based on 1100 cases: collective results from the UK Heart Valve Registry. Circulation. 1997;96:3403–8.
Fruitman DS, MacDougall CE, Ross DB. Cardiac surgery in octogenarians: can elderly patients benefit? Quality of life after cardiac surgery. Ann Thorac Surg. 1999;68:2129–35.
Craver JM, Puskas JD, Weintraub WS, et al. 601 Octogenarians undergoing cardiac surgery: outcome and comparison with younger age groups. Ann Thorac Surg. 1999;67:1104–10.
Grossi EA, Schwartz CF, Yu P-J, et al. High-risk aortic valve replacement: are the outcomes as bad as predicted? Ann Thorac Surg. 2008;85:102–7.
Grube E, Schuler G, Buellesfeld L, et al. Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis. J Am Coll Cardiol. 2007;50:69–76.
Walther T, Simon P, Dewey T, et al. Transapical minimally invasive aortic valve implantation: multicenter experience. Circulation. 2007;116 Suppl 1:I-240–5.
Webb JG, Chandavimol M, Thompson CR, et al. Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation. 2006;113:842–50.
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.
Shahian DM, O’Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3 – valve plus coronary artery bypass grafting surgery. Ann Thorac Surg. 2009;88(1 Suppl):S43–62.
Brown ML, Schaff HV, Sarano ME, et al. Is the European system for cardiac operative risk evaluation model valid for estimating the operative risk of patients considered for percutaneous aortic valve replacement. J Thorac Cardiovasc Surg. 2008;136:566–71.
Ross Jr J, Braunwald E. Aortic stenosis. Circulation. 1968;38:61–7.
Bach DS, Cimino N, Deeb GM. Unoperated patients with severe aortic stenosis. J Am Coll Cardiol. 2007;50:2018–9.
Bouma BJ, van den Brink RBA, van der Meulen JHP, et al. To operate or not elderly patient with aortic stenosis: the decision and its consequences. Heart. 1999;82:143–8.
Varadarajan P, Kappor N, Bansal RC, Pai RG. Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement: results from a cohort of 277 patients aged > or =80 years. Eur J Cardiothorac Surg. 2006;30:722–7.
Kojodjojo P, Gohil N, Barker D, et al. Outcomes of elderly patients aged 80 and over with symptomatic, severe aortic stenosis: impact of patient’s choice of refusing aortic valve replacement on survival. Q J Med. 2008;101:567–73.
Kapadia SR, Goel SS, Svensson L, et al. Characterization and outcome of patients with severe symptomatic aortic stenosis referred for percutaneous aortic valve replacement. J Thorac Cardiovasc Surg. 2009;137:1430–5.
Lieberman EB, Bashore TM, Hermiller JB, Wilson JS, Pieper KS, Keeler GP, et al. Balloon aortic valvuloplasty in adults: failure of procedure to improve long-term survival. J Am Coll Cardiol. 1995;26:1522–8.
Otto CM, Mickel MC, Kennedy JW, Alderman EL, Bashmore TM, Block PC, et al. Three-year outcome afer balloon aortic valvuloplasty. Insight into prognosis of valvular aortic stenosis. Circulation. 1994;89:642–50.
Ribera Casado JM. Cardiac surgery and the elderly. Rev Esp Cardiol. 2008;61:564–6.
Coromilas J. Obesity and atrial fibrillation: is one epidemic feeding the other? JAMA. 2004;292:2519–20.
Rosborough D. Cardiac surgery in elderly patients. Crit Care Nurse. 2006;26:24–31.
Dewey TM, Herbert MA. Predicting operative risk: a worthy task – an elusive goal, Editorial. Eur J Cardiothorac Surg. 2009;36:797–8.
Leontyev S, Walther T, Borger MA, et al. Aortic valve replacement in octogenarians: utility of risk stratification with EuroSCORE. Ann Thorac Surg. 2009;87:1440–5.
Wendt D, Osswald BR, Kayser K, et al. Society of Thoracic Surgeons score is superior to the EuroSCORE determining mortality in high risk patients undergoing isolated aortic valve replacement. Ann Thorac Surg. 2009;88:468–75.
Kalavrouziotis D, Li D, Buth KJ, Légaré JF. The European system for cardiac operative risk evaluation (EuroSCORE) is not appropriate for withholding surgery in high-risk patients with aortic stenosis: a restrospective cohort study. J Cardiothorac Surg. 2009;4:32.
Osswald BR, Gegouskov V, Badowski-Zyla D, Tochtermann U, Thomas G, Hagl S, et al. Overestimation of aortic valve replacement risk by EuroSCORE: implications for percutaneous valve replacement. Eur Heart J. 2009;30:74–80.
Dewey TM, Brown D, Ryan WH, Herbert MA, Prince SL, Mack MJ. Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement. J Thorac Cardiovasc Surg. 2008;135:180–7.
O’Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2 – isolated valve surgery. Ann Thorac Surg. 2009;88(1 Suppl):S23–42.
Thourani VH, Keeling WB, Guyton RA, Dara A, Hurst SD, Lattouf OM. Outcomes of off-pump aortic valve bypass surgery for the relief of aortic stenosis in adults. Ann Thorac Surg. 2011;91(1):131–6.
Melby SJ, Zierer A, Kaiser SP, et al. Aortic valve replacement in octogenarians: risk factors for early and late mortality. Ann Thorac Surg. 2007;83:1651–7.
Chiappini B, Camurri N, Loforte A, Di Marco L, Di Bartolomeo R, Marinelli G. Outcome after aortic valve replacement in octogenarians. Ann Thorac Surg. 2004;78:85–9.
Cerillo AG, Al Kodami AA, Solinas M, et al. Aortic valve surgery in the elderly patient: a retrospective review. Interact Cardiovasc Thorac Surg. 2007;6:308–13.
Likosky DS, Sorensen MJ, Dacey LJ, et al. Long-term survival of the very elderly undergoing aortic valve surgery. Circulation. 2009;120 Suppl 1:S127–33.
Kirsch M, Guesnier L, LeBesnerais P, et al. Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy. Ann Thorac Surg. 1998;66:60–7.
Kohl P, Lahaye L, Gerard P, et al. Aortic valve replacement in the octogenarians: perioperative outcome and clinical follow-up. Eur J Cardiothorac Surg. 1999;16:68–73.
Huber CH, Goeber V, Berdat P, Carrel T, Eckstein F. Benefits of cardiac surgery in octogenarians – a postoperative quality of life assessment. Eur J Cardiothorac Surg. 2007;31:1099–105.
de Vincentiis C, Kunkl AB, Trimarchi S, et al. Aortic valve replacement in octogenarians: is biologic valve the unique solution? Ann Thorac Surg. 2008;85:1296–301.
Odell JA, Mullany CJ, Schaff HV, et al. Aortic valve replacement after previous coronary artery bypass grafting. Ann Thorac Surg. 1996;62:1424–30.
Cribier A et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002;106:3006–8.
Carrel A. On the experimental surgery of the thoracic aorta and heart. Ann Surg. 1910;52:83–95.
Sarnoff SJ, Donovan TJ, Case RB. The surgical relief of aortic stenosis by means of apical-aortic valvular anastomosis. Circulation. 1955;11:564–74.
Al-Naaman YD. Bypass procedure for aortic stenosis simplified. Med Trib. 1963;4:27.
Gammie JS, Brown JW, Brown JM, et al. Aortic valve bypass for the high-risk patient with aortic stenosis. Ann Thorac Surg. 2006;81:1605–11.
Vassiliades Jr TA. Off-pump apicoaortic conduit insertion for high-risk patients with aortic stenosis. Eur J Cardiothorac Surg. 2003;23:156–8.
Gammie JS, Krowsoski LS, Brown JM, et al. Aortic valve bypass surgery: midterm clinical outcomes in a high-risk aortic stenosis population. Circulation. 2008;118:1460–6.
Lockowandt U. Apicoaortic valved conduit: potential for progress? J Thorac Cardiovasc Surg. 2006;132:796–801.
Brown JW, Girod DA, Hurwitz RA, et al. Apicoaortic valved conduits for complex left ventricular outflow obstruction: technical considerations and current status. Ann Thorac Surg. 1984;38:162–8.
Behrendt DM, Rocchini A. Relief of left ventricular outflow tract obstruction in infants and small children with valved extracardiac conduits. Ann Thorac Surg. 1987;43:82–6.
Nihill MR, Cooley DA, Norman JC, Hallman GL, McNamara DG. Hemodynamic observations in patients with left ventricule to aorta conduit. Am J Cardiol. 1980;45:573–82.
Fogel M, Rychik J, Chin A, Hubbard A, Weinberg PM. Evaluation and follow-up of patients with left ventricular apical to aortic conduits with 2D and 3D magnetic resonance imaging and Doppler echocardiography: a new look at an old operation. Am Heart J. 2001;141:630–6.
Thourani VH, Ailawadi G, Szeto WY, et al. Outcomes of surgical aortic valve replacement in high-risk patients: a multiinstitutional study. Ann Thorac Surg. 2011;91(1):49–55.
Shontz RD, Finley AC, Thourani V, Sniecinski RM. The use of transesophageal echocardiography for placement of apicoaortic conduit in a patient with a porcelain aorta. Anesth Analg. 2010;110:728–30.
Andersen HR et al. Transluminal implantation of artificial heart valves: description of a new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs. Eur Heart J. 1992;13:704–8.
Babaliaros V, Cribier A, Agatiello C. Surgery insight: current advances in percutaneous heart valve replacement and repair. Nat Clin Pract. 2006;3:256–64.
Cribier A et al. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. J Am Coll Cardiol. 2004;43:698–703.
Tron C et al. The RECAST study: short-term results after percutaneous aortic valve implantation in non-surgical patients with calcific aortic stenosis. Circulation. 2005;112 (Suppl II):2952.
Cribier A, Letac B. Two years’ experience of percutaneous balloon valvuloplasty in aortic stenosis. Herz. 1988;13:110–8.
Safian RD et al. Balloon aortic valvuloplasty in 170 consecutive patients. N Engl J Med. 1988;319:125–30.
NHLBI Balloon Valvuloplasty Registry. Percutaneous balloon aortic valvuloplasty: acute and 30-day follow-up results in 674 patients from the NHLBI Balloon Valvuloplasty Registry. Circulation. 1991;84:2383–97.
Cribier A, Letac B. Percutaneous balloon aortic valvuloplasty in adults with calcific aortic stenosis. Curr Opin Cardiol. 1991;6:212–8.
Grube E et al. Percutaneous implantation of the MCV self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study. Circulation. 2006;114:1616–24.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Thourani, V.H., Guyton, R.A. (2011). Surgical Treatment of Aortic Valve Disease in the Elderly. In: Katlic, M. (eds) Cardiothoracic Surgery in the Elderly. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0892-6_31
Download citation
DOI: https://doi.org/10.1007/978-1-4419-0892-6_31
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-0891-9
Online ISBN: 978-1-4419-0892-6
eBook Packages: MedicineMedicine (R0)