Transcript of video
Let’s discuss aortic valve replacement in elderly patients. Dr. Anton Titov, MD. You have very extensive experience in surgical operations on aortic valve. You have published a series of 493 consecutive elderly patients. You did an aortic valve replacement in very old patients. In half of those patients you also did Coronary Artery Bypass Grafting [CABG]. Dr. Anton Titov, MD. You did it close to the time of aortic valve replacement surgery or at the same time as heart valve surgery. These are patients who are over 80 years of age. What have you learned from this very large experience about heart surgery in elderly patients? Dr. Anton Titov, MD. What is the best method for aortic valve replacement in the elderly patient? How do you do aortic valve replacement in elderly patients, patients over 80 years of age? Dr. Jürgen Ennker, MD. Well, first we have to differentiate between the biological age and the numerical age. Because you have patients who are biologically much younger than near numerical age. They are more fit for a cardiac surgery operation. Second, you always have to listen to the patient. Sometimes the patient says. “I’m too old, this is nothing for me.” Don’t force the patient into any surgical operation. The patient has to want this operation. He has to follow the recommendations. He has to do what he has to do after the operation. He has to cough, he has to breathe. He has to mobilize himself. Dr. Jürgen Ennker, MD. Then we are able to get an adequate result of aortic valve replacement in the elderly patient. So listen to the patient. We also have to consider the risk factors. So if a patient is nearly 90 and he has had previous operations. Patient has a low cardiac output, he has renal disease. Then heart valve surgery may not be an adequate solution for this patient. But we are very fortunate for patients who are unoperable by conventional surgery. We have the so-called TAVI technique, transcatheter aortic valve implantation. We can place a catheter into the groin. We can bring the valve into the patient’s aortic annulus. Then we can replace the valve via end-vascular treatment. Dr. Jürgen Ennker, MD. There’s no need for regular operation. We just do the catheter procedure. So this is taking place in Germany right now. About 50% of elderly patients are operated interventionally by TAVI procedure. The other half of patients has a conventional procedure. So patients over 80 years of age, they have to make up their mind about the surgical procedure they want to have. Because an 80-year-old man in Germany has a life expectancy of 6.9 years. Women have a life expectancy about 8 years when the reach an age of 80 years. If a patient does not get aortic valve replacement operation, they will lose several years full of quality life. So this is very important. It’s not just a question of biological age. But it’s a question of how physically and mentally fit is the patient. It’s about a psychological desire to do an operation and to have a higher quality of life. Dr. Jürgen Ennker, MD. Absolutely! We have the so-called frailty index. Frailty index measures the ability of the patient to survive such surgical operation to replace aortic valve. This index measures his level of fitness, and this is very important. Dr. Anton Titov, MD.