Minimally Invasive Aortic Valve
Replacement Advantageous for Some Very Elderly Patients
Study suggests transcatheter aortic
valve implantation should be considered as treatment option even in
patients over age 85
Jan. 6, 2014 Older age is
increasingly becoming a defining cutoff for risky or costly surgery and
other medical treatments. A new study, however, has found a new treatment
for aortic stenosis in the very elderly 85 years and older that is
an effective alternative to surgical aortic valve replacement (AVR).
Stenosis is a condition when a heart valve doesn't open enough and
blocks blood flow.
Transcatheter aortic valve
implantation (TAVI) is the effective alternative for very elderly
patients, says a study in the January 2014 issue of The Annals of
With an aging population, the
number of patients who require cardiac surgery has increased among both
octogenarians (age 80-89 years) and nonagenarians; however, nearly
one-third of patients with severe symptomatic valve disease are not
recommended for surgery due to multiple comorbidities or advanced age.
Mansanori Yamamoto, MD, and
Emmanuel Teiger, MD, both from the Centre Hospitalier Universitaire
(CHU)-Henri Mondor in Creteil, France, led a group of researchers
examining TAVI results in very elderly patients.
Our study found TAVI to provide
acceptable clinical results in very elderly populations, said Dr.
Elderly patients generally require
more time to recover after invasive treatments, such as AVR, so TAVI may
have advantages because earlier mobility plays a significant role in
maintaining neuromuscular strength and physical function in elderly
patients. Smaller incisions allow faster resumption of physical activity
and therefore full recovery.
Your heart has four valves. Normally, these
valves open to let blood flow through or out of your heart, and
then shut to keep it from flowing backward. But sometimes they
don't work properly. If they don't, you could have
when blood leaks back through the valve in the wrong direction
Mitral valve prolapse- when one of the valves, the mitral
valve, has "floppy" flaps and doesn't close tightly. It's one of
the most common heart valve conditions. Sometimes it causes
Stenosis - when
the valve doesn't open enough and blocks blood flow
Valve problems can be present at birth or caused
by infections, heart attacks, or heart disease or damage.
The main sign of heart valve disease is an
unusual heartbeat sound called a heart murmur. Your doctor can
hear a heart murmur with a stethoscope. But many people have
heart murmurs without having a problem. Heart tests can show if
you have a heart valve disease.
Some valve problems are minor and do not need
treatment. Others might require medicine, medical procedures, or
surgery to repair or replace the valve.
For the study, researchers
collected data from 2,254 patients age 80 years and older who underwent
TAVI between January 2010 and October 2011 at any of the 34 hospitals
participating in the French national TAVI registry (FRANCE-2 Registry).
For the analysis, patients were divided into three categories based on
age: 80-84 years (867 patients), 85-89 years (1,064 patients), and ≥90
years (349 patients).
High procedural success was
achieved in every patient age group (97.8%, 96.3%, and 97.1%,
respectively), and both length of hospital stay and time in the
intensive care unit were similar in all groups.
Cumulative mortality rates for the
entire patient population were 9.9% at 30-days and 23.8% at 1-year
post-surgery. Mortality rates at 1-year were higher among patients in
the 85-89 and ≥90 year age groups, compared with the mortality rate in
patients in the 80-84 year age group (26.1%, 27.7%, and 19.8%,
TAVI may be a good therapeutic
option even in very elderly patients, said Dr. Teiger
Founded in 1964, The Society of
Thoracic Surgeons is a not-for-profit organization representing more
than 6,800 cardiothoracic surgeons, researchers, and allied health care
professionals worldwide who are dedicated to ensuring the best possible
outcomes for surgeries of the heart, lung, and esophagus, as well as
other surgical procedures within the chest. The Societys mission is to
enhance the ability of cardiothoracic surgeons to provide the highest
quality patient care through education, research, and advocacy.
The Annals of Thoracic Surgery
is the official journal of STS and the Southern Thoracic Surgical
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