Bouma, Bonno N.

Cheriex, EC

Hamer, HPM

Lie, KI

Tijssen, JGP

van den Brink, RBA

van der Meulen, JHP

Verheul, HA

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 (greater than or equal to 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.</p

Dissertations of the University of Groningen

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

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

Abstract

Similar works

Full text

Available Versions

Dissertations of the University of Groningen