Aortic valve replacement in elderly patients: what are the limits?

Abstract

Increased life expectancy has led to a growing elderly population frequently presenting with aortic stenosis. This review focuses on modalities of aortic valve replacement designed to cope with the risks from multiple co-morbidities prevalent in the elderly. Cardiac surgery is safe in octogenarians; very low risks are associated with aortic valve replacement. Good short-term and medium-term results are seen with early surgical intervention for aortic stenosis in the relatively asymptomatic patient. The benefits seen with minimally invasive surgery make it more acceptable. A hybrid approach that deploys a drug-eluting stent for concomitant moderate coronary artery disease has shown promising results. An extension of this concept is the percutaneous aortic valve implantation that offers hope to the nonsurgical candidate. A systematic approach of minimally invasive surgery in patients with prior coronary artery bypass grafting minimizes injury to grafts. Bioprosthetic tissue valves are the valves of choice in all the above interventions. Cardiac surgery is used increasingly for aortic stenosis in elderly patients. Current experiences in minimally invasive and percutaneous approaches have opened the doors to hybrid strategies, which may be the mainstay of treatment for older patients needing aortic valve replacements in the future.