Degenerative Aortic Valve Disease, its Mechanism on Progression, its Effect on the Left Ventricle and the Postoperative Results

Aortic Valve Replacement in Patients Aged Over 80 Years

Author(s): Wilhelm Peter Mistiaen

Pp: 224-238 (15)

DOI: 10.2174/9781608052875113010012

* (Excluding Mailing and Handling)

Abstract

The life expectancy in the Western societies has increased steadily. CAVS is usually occurring at a higher age, therefore its incidence is also rising. However, the diagnosis of CAVS in elderly is not always easy: the disease might be overlooked because its symptoms sometimes are not recognized. Moreover, ascertaining the valvular origin of the symptoms in elderly patients might be a challenge.

If the presence of a symptomatic CAVS has been established in an elderly patient, the optimal treatment still has to be decided. Age, frailty, co-morbid conditions and LVF all have played a role in this decision making. It has become clear that there were and still are different approaches of cardiologists in regard to the referral policy.

Unto recently, about one third of the patients has been denied AVR unjustly. The EuroSCORE overestimates the postoperative mortality, especially in high risk patients, and should be used with great caution.

The available postoperative results seem to justify a referral of octogenarians with symptomatic CAVS for AVR. Hospital and long-term adverse events in these elderly patients are more frequent, compared to their younger counterparts. There is, however, a considerable variation in postoperative results, which is probably due to differences in the baseline characteristics of the patients. This finding applies for patients of all ages, including octogenarians.

The study of risk factors has revealed that need for urgent surgery has a dominant effect on the postoperative results. This factor is more present in elderly, indicating that poor postoperative results in elderly could be a self fulfilling prophecy. Long-term postoperative results in octogenarians show that, compared to the general population, a normal age and gender matched survival might be reached, with an acceptable quality of life.


Keywords: CABG, co-morbidity, coronary artery disease, EuroSCORE, frailty, hospital mortality, independent predictors, left ventricular function, long-term mortality, octogenarians, quality of life, stentless valves.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316316526 and j.to_ip >=316316526 )) and ((j.from_date <= 1739848508 and j.to_date >= 1739848508 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4702) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316316526 and j.to_ip >=316316526 )) and ((j.from_date <= 1739848508 and j.to_date >= 1739848508 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4702) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316316526 and j.to_ip >=316316526 )) and ((j.from_date <= 1739848508 and j.to_date >= 1739848508 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4702)
      950μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1141 and `b`.`banner_from_date` <= 1739848508 and `b`.`banner_to_date` >= 1739848508 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.08msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1141
      • 3: 1739848508
      • 4: 1739848508
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='ace5bc01bd1eaa97e210cf1038f8d8c6'
      290μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    12Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        MPfIiLNxR7XSWey0uW1Xr2ycsdtiEh2UxJIGYism
        uc_cart_id
        ace5bc01bd1eaa97e210cf1038f8d8c6
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/4702" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/4702
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
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        response_headers
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        ClearShow all
        Date ↕MethodURLData
        #12025-02-18 03:15:08GET/chapter/47021121914