Korean J Thorac Cardiovasc Surg 2018; 51(5): 322-327  https://doi.org/10.5090/kjtcs.2018.51.5.322
Aortic Valve Replacement for Aortic Stenosis in Elderly Patients (75 Years or Older)
Bongyeon Sohn, M.D., Jae Woong Choi, M.D., Ho Young Hwang, M.D., Ph.D., Kyung Hwan Kim, M.D., Ph.D., Ki-Bong Kim, M.D., Ph.D.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital,
Seoul National University College of Medicine
Corresponding author: Ho Young Hwang, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
(Tel) 82-2-2072-3020 (Fax) 82-2-2072-2340 (E-mail) scalpel@hanmail.net
Received: June 19, 2018; Revised: July 26, 2018; Accepted: August 2, 2018.; Published online: October 5, 2018.
© The Korean Journal of Thoracic and Cardiovascular Surgery. All rights reserved.

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Abstract
Background: This study evaluated the early and long-term outcomes of surgical aortic valve replacement (AVR) in elderly patients in the era of transcatheter aortic valve implantation.
Methods: Between 2001 and 2018, 94 patients aged ≥75 years underwent isolated AVR with stented bioprosthetic valves for aortic valve stenosis (AS). The main etiologies of AS were degenerative (n=63) and bicuspid (n=21). The median follow-up duration was 40.7 months (range, 0.6–174 months).
Results: Operative mortality occurred in 2 patients (2.1%) and paravalvular leak occurred in 1 patient. No patients required permanent pacemaker insertion after surgery. Late death occurred in 11 patients. The overall survival rates at 5 and 10 years were 87.2% and 65.1%, respectively. The rates of freedom from valve-related events at 5 and 10 years were 94.5% and 88.6%, respectively. The Society of Thoracic Surgeons (STS) score (p=0.013) and chronic kidney disease (p=0.030) were significant factors affecting long-term survival. The minimal p-value approach demonstrated that an STS score of 3.5% was the most suitable cut-off value for predicting long-term survival.
Conclusion: Surgical AVR for elderly AS patients may be feasible in terms of early mortality and postoperative complications, particularly paravalvular leak and permanent pacemaker insertion. The STS score and chronic kidney disease were associated with long-term outcomes after AVR in the elderly.
Keywords: Aortic valve replacement, Aortic valve stenosis, Aged, Transcatheter aortic valve implantation


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