Prognosis of octogenarians with severe aortic valve stenosis at high risk for cardiovascular surgery

Background Calcified aortic valve stenosis (AVS) is a disease found in the elderly which is often complicated by severe co-morbidities. Aims To assess the survival of conservatively treated patients >75 years with severe AVS compared to patients with non-severe AVS but who have a similar clinical risk profile; and to identify risk factors affecting prognosis. Methods and results From 2002 to 2006, 161 patients (mean age 86+/-67.7 years) were studied: 79 with aortic valve area (AVA) <1 cm(2) (group A), 82 with AVA >= 1 cm(2) (group B). Cumulative mortality rates were 77.5% in group A, and 44.4% in group B. Survival rates at 6, 12, 18 and 24 months in groups A and B were: 70.9% versus 98.8%, 65.8% versus 84.1%, 49.4% versus 69.5% and 41.8% versus 59.8%, respectively. Independent predictors for death in group A were pulmonary artery pressure (PAP), the STS-PROM score, serum creatinine and diabetes. PAP >30 mm Hg identified patients at high mortality risk. In group B the predictive variables were ejection fraction, PAP, serum creatinine, and treatment with beta-blockers or ACE inhibitors. Conclusion Severe aortic valve stenosis is a medical condition with limited short-term survival in patients over the age of 75 years at high surgical risk. Clinical variables rather than symptomatic status were able to predict the patients' outcome. Patients with the highest surgical risk have the worst prognosis if AVS is not treated.