Circulation, Vol 90, 2891-2898, Copyright © 1994 by American Heart Association
Y Logeais, T Langanay, R Roussin, A Leguerrier, C Rioux, J Chaperon, C de Place, P Mabo, JC Pony and JC Daubert
BACKGROUND: Aortic stenosis is the most common valvular lesion occurring
among elderly patients and has become extremely frequent because of
changing demographics in industrialized countries. Surgical risk after the
age of 70 has increased. The increasing older age of patients having
surgery justifies an analysis of mortality predictive factors. METHODS AND
RESULTS: Between 1976 and February 1993, we performed 2871 operations for
aortic stenosis. This study concerns 675 patients (278 men and 397 women)
who were > or = 75 years old. Mean age was 78.5 +/- 3 years. Associated
lesions were found in 226 patients. A bioprosthesis was implanted in 632
patients (93.6%). Concomitant surgical procedures were performed in 133
patients. Surgical mortality was 12.4% (84 deaths). A longitudinal analysis
has been carried out over four successive time periods to evaluate
population evolution during these 17 years. Statistical analysis was
performed on 46 variables. Multivariate analysis found age (P < .0001),
left ventricular failure (P < .0001), lack of sinus rhythm (P < .01),
and emergency status (P < .02) to be presurgical independent predictive
factors of mortality. CONCLUSIONS: Risk-reducing strategy should both favor
relatively early surgery to avoid cardiac failure and emergency situations
and pay careful attention to the use of myocardial protection and
cardiopulmonary bypass. Indications for surgery should remain broad since
analysis failed to determine specific high-risk groups to be eliminated,
and surgery remains the only treatment for aortic stenosis.
ARTICLES
Surgery for aortic stenosis in elderly patients. A study of surgical risk and predictive factors
Clinic for Cardiovascular and Thoracic Surgery, University Hospital Center, Rennes, France.
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