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. 1999 Aug;82(2):143-8.
doi: 10.1136/hrt.82.2.143.

To operate or not on elderly patients with aortic stenosis: the decision and its consequences

B J Bouma  1 , R B van Den Brink, J H van Der Meulen, H A Verheul, E C Cheriex, H P Hamer, E Dekker, K I Lie, J G Tijssen
Affiliations

To operate or not on elderly patients with aortic stenosis: the decision and its consequences

B J Bouma et al. Heart. 1999 Aug.

Abstract

Objective: To evaluate the application of guidelines in the decision making process leading to medical or surgical treatment for aortic stenosis in elderly patients.

Design: Cohort analysis based on a prospective inclusive registry.

Setting: 205 consecutive patients (>/= 70 years) with clinically relevant isolated aortic stenosis and without serious comorbidity, seen for the first time in the Doppler-echocardiographic laboratories of three university hospitals in the Netherlands.

Results: The initial choice was surgery in 94 patients and medical treatment in 111. Only 59% of the patients who should have had valve replacement according to the practice guidelines were actually offered surgical treatment. These were mainly symptomatic patients under 80 years of age with a high gradient. Operative mortality (30 days) was only 2%. The three year survival was 80% in the surgical group (17 deaths among 94 patients) and 49% in the medical group (43/111). Multivariate analysis showed that only patients with a high baseline risk, mainly determined by impaired left ventricular function, had a significantly better three year survival with surgical treatment than with medical treatment.

Conclusions: In daily practice, elderly patients with clinically relevant symptomatic aortic stenosis are often denied surgical treatment. This study indicates that a surgical approach, especially where there is impaired systolic left ventricular function, is associated with better survival.

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Figures

Figure 1
Figure 1
Survival in elderly patients with aortic stenosis stratified by treatment.
Figure 2
Figure 2
Survival in patients with (A) low, (B) intermediate, and (C) high individual risk score, stratified by treatment.
See this image and copyright information in PMC

Comment in

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