Abstract
A cases report of successful surgical treatment of critical aortic stenosis in the volume of valve replacement in patients over 90 years of age are rare. The presence of an impressive list of clinically significant comorbidities that increase operational and anesthetic risks and are the reason for the impossibility of taking anticoagulants makes it difficult to choose treatment tactics. Before making a decision, it is necessary to take into account the stage and severity of the disease, as well as criteria such as the predicted life expectancy and the ratio of “benefit – harm”. The article describes a clinical case of aortic valve replacement with a biological xenopericardial prosthesis “BioLAB” No. 22 without postoperative complications in a 91-year-old patient with critical calcified stenosis of the aortic valve. Open surgery of aortic valve replacement with a biological prosthesis made it possible to achieve a clinical and hemodynamic positive effect, which, in turn, led to a significant improvement in quality and an increase in life expectancy.
References
- Bockeria L.A., Gazal B. «Prosthesis-patient mismatch» in patients undergoing aortic valve replacement. Annals of Surgery. 2012; 2: 5–9 (in Russ.).
- Stehli J., Koh J.Q.S., Duffy S.J., Zamani J., Yeong Ch.Ch., Paratz E. et al. Comparison of outcomes of transcatheter aortic valve implantation in patients aged > 90 years versus < 90 years. Am. J. Cardiol. 2019; 124 (7): 1085–90. DOI: 10.1016/j.amjcard.2019.06.026
- Vendrik J., van Mourik M.S., van Kesteren F., Henstra M.J., Piek J.J., Henriques J.P.S. et al. Comparison of outcomes of transfemoral aortic valve implantation in patients < 90 with those > 90 years of age. Am. J. Cardiol. 2018; 121 (12): 1581–6. DOI: 10.1016/j.amjcard.2018.02.056
- Otto C.M., Bonow R.A.R.O., Carabello B.A., Erwin J.P. III, Gentile F., Jneid H. et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021; 143: 72–227. DOI: 10.1161/CIR.0000000000000923
- Zheleznev S.I., Isayan M.V., Astapov D.A., Tuleutaev R.M., Semenova E.I. Aortic valve replacement with stented bioprosthesis BioLAB KA/PT in elderly and old patients. Siberian Medical Journal (Irkutsk). 2012; 27 (3): 72–6 (in Russ.).
- Baumgartner H., Falk V., Bax J.J., De Bonis M., Hamm Ch., Holm P.J. et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur. Heart J. 2017; 38 (36): 2739–91. DOI: 10.1093/eurheartj/ehx391
- Aortic stenosis. Clinical recommendations. http://www.racvs.ru/aortic-stenosis.pdf (in Russ.).
- Sponga S., Isola M., Bagur R., Torracchi L., Mazzaro E., Grillo M.T. et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients over 85 years old. J. Thorac. Cardiovasc. Surg. 2017; 25 (4): 526–32. DOI: 10.1093/icvts/ivx180
About the authors
- Leo A. Bockeria, Academician of RAS and RAMS, President of Center; ORCID
- Zamik F. Fatulaev, Cand. Med. Sci., Leading Researcher; ORCID
- Teymuraz N. Kanametov, Cand. Med. Sci., Junior Researcher; ORCID
- Vladimir A. Shvarts, Dr. Med. Sci., Researcher; ORCID
- Zalim G. Panagov, Resident Physician; ORCID
- Mariya A. Sokol’skaya, Cand. Med. Sci., Researcher, Cardiologist; ORCID
