J Heart Valve Dis
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Operative risk is assessed preoperatively through the use of predictive scores. The study aim was to evaluate the validity of five different scoring systems, including the Society of Thoracic Surgeons (STS) score, additive and logistic European systems (EuroSCORE 1) for cardiac operative risk evaluation, EuroSCORE 2, and the Ambler score in octogenarian patients undergoing aortic valve replacement (AVR). ⋯ The STS score appeared to be more adequate for predicting operative mortality among patients aged > or = 80 years. STS scores were predictive of both one-year and long-term survival rates. These results indicated that the STS score could be used to guide clinical decision-making for performing AVR in elderly patients.
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Comparative Study
Advanced age per se should not be an exclusion criterion for minimally invasive aortic valve replacement.
The introduction of transcatheter aortic valve implantation (TAVI), coupled with the increasing number of elderly patients requiring cardiac surgery, has given rise to an intense debate on the most appropriate treatment strategy for this high-risk population. The study aim was to compare clinical outcomes in older versus younger patients undergoing minimally invasive aortic valve replacement (AVR). ⋯ Within the setting of minimally invasive isolated AVR, the study results showed that the clinical outcomes and quality of life in patients aged > or = 80 years were comparable to those of younger patients. Therefore, advanced age per se does not preclude successful AVR through a minimally invasive approach.
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For patients who require aortic root replacement but are unwilling or unable to receive anticoagulants, a composite conduit was assembled intraoperatively that contained a stented biological valve sutured inside a vascular tube graft, rather than at its extremity. This simple modification of the Bentall concept may provide several advantages. The results obtained with this conduit over an 11-year period were analyzed. ⋯ This valved conduit is a safe and durable option for replacing the aortic root, thus facilitating the technique of implantation and simplifying reoperation in the case of valve failure.