**4. Summary**

Aortic valve replacement is the most commonly performed valve operation. It has been shown to be an effective therapy in all age groups, including the very elderly (age > 90 years). The most common etiologies for AS are calcific degeneration, rheumatic disease, and congenital bicuspid valves. The most common causes of pure aortic regurgitation include annuloaortic ectasia and associated dilation of the aortic root, endocarditis, aortic dissection, and rheumatic disease. The indications for surgery depend on the pathophysiology and symptoms. The choice of the prosthesis can be difficult and depends on multiple clinical and lifestyle considerations. Early and late outcomes are generally quite good, even in high-risk patients.

**35**

**Author details**

Adam El Gamel1,2,3

New Zealand

New Zealand

1 Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand

2 Faculty of Medical and Health Sciences, The University of Auckland, Auckland,

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

3 University of Waikato Medical Research Centre, The University of Waikato,

\*Address all correspondence to: aelgamel@aol.com

provided the original work is properly cited.

*Aortic Valve Disease: State of the Art*

*DOI: http://dx.doi.org/10.5772/intechopen.93311*

*Aortic Valve Disease: State of the Art DOI: http://dx.doi.org/10.5772/intechopen.93311*

*Advances in Complex Valvular Disease*

4.9% with an observed stroke rate of 2.0%.

in patients younger than 50 years.

requiring pacemaker insertion is 3–5% [76].

*3.13.7.5 Complications*

**4. Summary**

high-risk patients.

1.9%, and the length of stay was as short as 5 days [72].

Data from the STS indicates that the operative mortality for patients 70 years of age or older who underwent isolated AVR or AVR with coronary artery bypass grafting surgery (CABG) between 1994 and 2003 fell from 10% to less than 6% [71]. In the most recent analysis using the STS database on 108,687 patients from 1997 to 2006 with a mean age of 68 years undergoing isolated AVR, the in-hospital mortality was 2.6% with an observed stroke rate of 1.3% and length of stay of 7.8 days for the year 2006. Among patients 80–85 years of age, 30-day mortality was

Experience at centres of excellence within the last 5 years has demonstrated significantly improved operative mortality, less than 1%, after isolated AVR. The incidence of perioperative stroke in these contemporary series ranged from 0% to

In the prospective, randomised, multicenter Placement of Aortic Transcatheter Valves (PARTNER) trial comparing high-risk patients (mean STS score 11.8%) receiving TAVI or AVR for severe, symptomatic AS, outcomes for both procedures were excellent [73]. Patients undergoing AVR (n = 351, mean age 85 years) had a 30-day mortality of 6.5%, setting a new benchmark for operative outcomes in a high-risk cohort of patients treated at centres of excellence [74]. Moreover, comparative results showed that early and late strokes and transient ischemic attacks were significantly lower in the AVR group than the TAVI group (30 days, 2.4% vs. 5.5%, respectively, P = 0.04; 1 year, 4.3% vs. 8.3%, respectively, P = 0.04) [75]. Freedom from reoperation depends on both the prosthesis and patient age. Although they do not degenerate, modern mechanical valves do have a finite reoperation rate of 0.5–1% per year from endocarditis, pannus overgrowth, and thrombosis. Actual freedom from reoperation of modern bioprostheses at 15 years approaches 100% in elderly patients older than 70 years, but it can be as low as 50%

The most common complications following aortic valve surgery are similar to those of other cardiac surgeries and include stroke (1–4%), deep sternal wound infection (1–2%), reoperation for bleeding (1–3%), and myocardial infarction (MI; 1–5%). Transient heart block is not uncommon, presumably as a result of traction or oedema of the bundle of His in the vicinity of the right noncoronary commissure. It usually resolves within 5–6 days of surgery. The risk of complete heart block

Aortic valve replacement is the most commonly performed valve operation. It has been shown to be an effective therapy in all age groups, including the very elderly (age > 90 years). The most common etiologies for AS are calcific degeneration, rheumatic disease, and congenital bicuspid valves. The most common causes of pure aortic regurgitation include annuloaortic ectasia and associated dilation of the aortic root, endocarditis, aortic dissection, and rheumatic disease. The indications for surgery depend on the pathophysiology and symptoms. The choice of the prosthesis can be difficult and depends on multiple clinical and lifestyle considerations. Early and late outcomes are generally quite good, even in

*3.13.7.4 Outcomes*

**34**
