**6. References**


Patients with an aortic valve pathology and a severely reduced ejection fraction constitute a significant challenge. However, in light of the recent inventions, innovations, new technologies and strategies for this patient cohort we are positive that the scientist and medical professionals in the field of cardiovascular medicine will be able to tackle this

Ali A. et al. 2006 Are Stentless Valves Superior to Modern Stented Valves? A prospective

Bonow R. et al. 2006. ACC/AHA 2006 Guidelines for the Management of Patients with

Bottio T. et al. 2007. Heart valve surgery in a very high-risk population: a preliminary experience in awake patients. J Heart Valve Dis. 2007 Mar; 16(2):187-94.

Chaliki HP, et al. 2002 Outcomes after aortic valve replacement in patients with severe aortic

Clavel MA et al. 2008 Predictors of Outcome in Low-Flow, Low Gradient Aortic Stenosis

Fedoruk L, et al. 2008 Statin Therapy Improves Outcomes After Valvular Heart Surgery;

Flameng W et al. 2011 Effect of sutureless implantation of the Perceval S aortic valve

Grossi E, et al. 2008 High-Risk Aortic Valve Replacement: Are the Outcomes as Bad as

Hannan E, et al. 2009 Aortic Valve Replacement for Patients with severe aortic stenosis:

Hashimoto K et al. 2006 Patient-Prosthesis Mismatch: The Japanese Experience; Ann Thorac

Himbert D et al. 2009 Results of transfemoral or transapical aortic valve implantation

Järvelä K et al. 2008 Levosimendan in aortic valve surgery: cardiac performance and

Kocher A et al. 2011 Technical consideration regarding the implantation of a novel

Lazar, L et al. Transcatheter Aortic Valves — Where Do We Go from Here? N Engl J Med

Leon M.B., et al. 2010. Transcatheter aortic-valve implantation for aortic stenosis in patients

recovery. J Cardiothorac Vasc Anesth. 2008 Oct; 22(5):693-8.

who cannot undergo surgery. N Engl J Med 2010;363:1597-1607

Valvular Heart disease; Journal of the American College of Cardiology Vol. 48, No.

regurgitation and markedly reduced left ventricular function. Circulation. 2002

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bioprosthesis on intraoperative and early postoperative outcomes. J Thorac

Risk Factors and Their Impact on 30-Month Mortality; Ann Thorac Surg 2009;

following a uniform assessment in high-risk patients with aortic stenosis. J Am Coll

Randomized trial; Circulation. 2006; 114[suppl I]:I-535-I-540.

Carabello B., Walter P. 2009 Aortic Stenosis; Lancet 2009; 373:956-66

problem.

**6. References** 

3, 2006

S242

87:1741-50

Cardiol 2009; 54:303

Nov 19; 106(21):2687-93.

Ann Thorac Surg 2008; 85:1521-1526

Predicted? Ann Thorac Surg 2008; 85:102-7

Cardiovasc Surg. 2006 Jun; 12 (3):159-65

sutureless valve, 2011 ISMIC meeting

2010; 363:1667-1668 October 21, 2010

Cardiovasc Surg. 2011 Apr 5


**10** 

*France* 

**Relationship Between** 

*1Centre Cardiologique du Nord, Saint-Denis, 2Hopital Européen Georges Pompidou, Paris,* 

Jean-Michel Maillet1 and Dominique Somme2

**Aortic Valve Replacement and Old Age** 

Many factors can explain the most important increase of human life expectancy during the XXth century: better socioeconomic conditions, improved working conditions, development of preventive measures, less alcoholism, appearance of antibiotics, advances in medical practices, etc… At present, the fastest growing age group in western countries is people >80 years old; they will represent 9–10.5% of the population in those countries in 2050. Today, life expectancy at 80 years is, on average, 10 years for a woman and 7 years for a man in western countries (Health at a glance OECD indicators). This population is at high risk of cardiovascular disease (Assey, 1993). More specifically, aortic stenosis (AS) is the most frequent valvulopathy in adults ≥ 75 years old, being present in as many 4.6% (Nkomo et al., 2006). Progress made in anesthesia, surgery and intensive care explain why doctors, surgeons and cardiologists are less-and-less reluctant to propose aortic valve replacement

However, for this very specific population, many questions remain to be answered before


Above all, the natural history of severe aortic stenosis (SAS) has a dismal prognosis. Once symptoms appear, life expectancy is 5 years for angina, 3 years for dyspnea or syncope and 2 years for cardiac failure (Chizner et al., 1980; Ross and Braunwald, 1968). Even though those results were obtained from old studies conducted during the 1960s and 1970s (Chizner et al., 1980; Horstkotte & Loogen, 1988; Ross & Braunwald, 1968), concerned young patients



**1. Introduction** 

(AVR) for older-and-older patients.

intermediate and long term?


**2.1 Natural history of severe AS** 



**2. Rationale for proposing surgical AVR for the elderly** 

such surgery can be undertaken:

