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Eur J Cardiothorac Surg 2006;30:713-715
© 2006 Elsevier Science NL

Editorial comment

Aortic stenosis in the elderly: rethinking strategies

Department of Cardiothoracic Surgery, University Hospital, Coimbra, Portugal

^_* Tel.: +351 239 400418; fax: +351 239 829674. (Email: antunes.cct.huc@sapo.pt).

The first 20% of the full text of this article appears below.

In this issue of the Journal, Bové et al. [1] report a retrospective study of 145 elderly patients (mean age 75 years) with aortic stenosis who received a Toronto stentless prosthesis and compare them with 110 similar patients (mean age 76 years) who received a stented Carpentier-Edwards valve. Although the definition of elderly is not disclosed, it can be presumed that the classical cut-off age of 65 years was used. However, the series is obviously composed of a majority of patients in their late 70s and in their 80s. They were followed clinically and by Doppler-echocardiography for a mean of 47–56 months to assess transprosthetic gradients and to accompany the evolution of LV wall-mass (LVM) and the respective index (LVMI), which was analysed and correlated to ‘specific prosthesis and patient-related factors’, especially patient-prosthesis mismatch (PPM). Effective orifice areas (EOA) and indexed EOA were estimated from available in vitro tables rather than in vivo (echocardiographic), which could have been more representative.

The authors found that clinical improvement occurred in most patients and was independent of PPM. Although there was a significant difference of survival at the 5-year period in favour of the stentless valve group, this difference had disappeared after 8 years. Only advanced age, NYHA class IV and excessive pre-operative LV hypertrophy . . . [Full Text of this Article]