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Health & Medicine for Senior Citizens

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 Thoracic Surgery.

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.


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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. Yamamoto.

“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.”

Heart Valve Diseases - MedlinePlus

Also called: Valvular heart disease 

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

Regurgitation - 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 regurgitation.

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.

NIH: National Heart, Lung, and Blood Institute

More at American Heart Association

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%, respectively).

“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 Society’s 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 Association.


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