December 4, 1969

Aortic Stenosis in the Elderly

Structured PICO

Does surgical intervention improve survival and symptoms in elderly patients with severe isolated aortic stenosis?

Population

78 patients over the age of 60 (average age 64, maximum 80) with severe aortic stenosis as an isolated valvular lesion.

Intervention

Surgery (valve debridement [n=9], prosthetic valve replacement [n=52], or homograft replacement [n=9]) in 70 patients.

Outcome

Operative mortality, late mortality, and symptomatic improvementhard clinical

Surgical treatment of severe isolated aortic stenosis in elderly patients is associated with acceptable mortality and marked symptomatic improvement, justifying an aggressive approach.

Abstract

In 78 patients over the age of 60 (average age of 64, the eldest being 80) who had severe aortic stenosis as an isolated valvular lesion, historical and physical findings proved to be similar to those in younger patients with severe aortic stenosis. In the older group the brachial arterial pulse pressure tended to be wide (60 to 65 mm of mercury), and the systolic arterial pressure exceeded 149 mm of mercury in 16 patients, including 13 of the 70 who were referred for surgery. The definitive diagnostic test was catheterization of the left side of the heart. Seventy patients underwent surgery, either valve debridement (nine), prosthetic valve replacement (52) or homograft replacement (nine). The operative mortality was 11.5 per cent, and the late mortality 20 per cent. Forty-four of the 48 survivors reported continued marked improvement (average survival of 25 months). These results justify an aggressive approach in the elderly patient with aortic stenosis.

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