Aortic Valve Replacement Options for Elderly Patients

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• Biological Age vs. Numerical Age
• Importance of Patient Consent
• Risk Factors in Elderly Surgery
• Transcatheter Aortic Valve Implantation
• Frailty Index and Quality of Life
• Full Transcript

Biological Age vs. Numerical Age

Dr. Jürgen Ennker, MD, emphasizes the distinction between biological and numerical age when considering aortic valve replacement in elderly patients. Biological age reflects a patient's physical condition and fitness level, which can significantly impact their suitability for surgery. Some patients over 80 may be biologically younger and more fit for cardiac operations, making them better candidates for surgery.

Importance of Patient Consent

Dr. Jürgen Ennker, MD, stresses the importance of patient consent and willingness when deciding on aortic valve replacement. Patients must express a desire for the operation and be prepared to follow post-operative recommendations, such as breathing exercises and mobilization. A patient's psychological readiness and motivation are crucial for achieving successful surgical outcomes.

Risk Factors in Elderly Surgery

Dr. Jürgen Ennker, MD, highlights several risk factors that must be considered before proceeding with surgery in elderly patients. These include previous operations, low cardiac output, and renal disease. For patients nearing 90 with significant risk factors, conventional surgery may not be the best option. Evaluating these risks is essential to ensure patient safety and optimize surgical outcomes.

Transcatheter Aortic Valve Implantation

For patients unsuitable for conventional surgery, Dr. Jürgen Ennker discusses the benefits of transcatheter aortic valve implantation (TAVI). This minimally invasive procedure involves placing a catheter into the groin to replace the aortic valve, eliminating the need for open-heart surgery. TAVI offers a viable alternative for high-risk patients, with approximately 50% of elderly patients in Germany undergoing this procedure.

Frailty Index and Quality of Life

The frailty index is a critical tool in assessing a patient's ability to withstand surgery and their overall fitness level. Dr. Jürgen Ennker explains that this index helps determine the likelihood of a successful outcome and improved quality of life post-surgery. For elderly patients, aortic valve replacement can significantly extend life expectancy and enhance life quality, making it a valuable consideration for those who are fit and willing.

Full Transcript

Dr. Anton Titov, MD: Let's discuss aortic valve replacement in elderly patients. You have very extensive experience, having published a series of 493 consecutive elderly patients in whom you performed an aortic valve replacement. In half of those patients, you also did Coronary Artery Bypass Grafting (CABG), either close to the time of aortic valve replacement surgery or together. These are patients who are over 80 years of age.

Dr. Jürgen Ennker, MD: What have you learned from your very large experience about heart surgery in elderly patients? What is the best way, how do you approach in your practice aortic valve replacement in elderly patients over 80 years of age?

Dr. Jürgen Ennker, MD: First, we have to differentiate between the biological age and the numerical age, because you have patients who are biologically much younger, and they are more fit for a cardiac operation. Second, you always have to listen to the patient. If the patient says, "I'm too old, this is nothing for me," don't force the patient into any operation. The patient has to want this operation and follow the recommendations for post-operative care. They need to cough, breathe, and mobilize themselves to achieve an adequate result.

Dr. Jürgen Ennker, MD: We also have to consider the risk factors. If a patient is nearly 90, has had previous operations, is in low cardiac output, or has renal disease, surgery may not be an adequate solution. Fortunately, for patients who are inoperable by conventional surgery, we have the TAVI technique, transcatheter aortic valve implantation. We can place a catheter into the groin, bring the valve into the patient's aortic annulus, and replace the valve without a regular operation, just the catheter procedure.

Dr. Jürgen Ennker, MD: This is taking place in Germany right now. About 50% are operated interventionally by such a TAVI procedure, and the other half undergo a conventional procedure. Patients over 80 have to make up their minds because, for example, a man in Germany at 80 has a life expectancy of 6.9 years, and women have about 8 years. Without such an operation, they will lose several years full of quality life.

Dr. Jürgen Ennker, MD: So this is very important. It's not just a question of biological age, but it's a question of the patient's fitness and psychological desire to undergo an operation and have a higher quality of life.

Dr. Jürgen Ennker, MD: Absolutely! We have the so-called frailty index, which measures the ability of the patient to survive such an operation and their level of fitness, and this is very important.