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International Society For Minimally Invasive Cardiothoracic Surgery

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Aortic Valve Replacement In Elderly High Risk Patients Including Minimally Invasive Approach -the Population Analysis And Early Outcomes
Anna Kwiecien, Tomasz Hrapkowicz, Michal O. Zembala.
Silesian Center for Heart Disease, Zabrze, Poland.

BACKGROUND
In the era of the TAVI procedures, the need to analyze elderly patients at high surgical operative risk still remains very important. Due to the high costs and limited availability of TAVI procedures in some countries, surgical management still requires careful analysis to assess the safety of surgical method.
METHODS
In the period between 2004-2019, 70 patients aged 75 years and more were operated due to severe aortic stenosis, in whom the operative risk was above 4% according to the EuroSCORE II. Retrospective analysis excluded patients undergoing other cardiac procedures, infective endocarditis, re-do or the presence of severe aortic valve regurgitation as the main indication. Preoperative data and echocardiographic parameters were analyzed. Operative EuroSCORE II risk was 6.8% (+/- 4.5).
RESULTS
In most cases a biological prosthesis was used, 19 patients (27.1%) underwent minimally invasive surgery. There were 3 hospital deads (4.3%) and average hospital stay was 8.7 days (+/- 3.1), the implantations of the pacemaker were necessary in 2 patients (2.9%). The postoperative parameters is presented in Table 1.
CONCLUSIONS
Despite the high predictable operational risk, the surgical method still remains a valuable invasive treatment of severe aortic stenosis also among older high-risk patients.

Table 1
N%
Mortality34,3
Adernalin34,4
IABP00
new AF1420
psychosis710
stroke11,4
Renal imairment1420
Hemofiltration45,7
pacemaker22,9


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