Relationship Between Aortic Valve Replacement and Old Age

Many factors can explain the most important increase of human life expectancy during the XXth century: better socioeconomic conditions, improved working conditions, development of preventive measures, less alcoholism, appearance of antibiotics, advances in medical practices, etc... At present, the fastest growing age group in western countries is people >80 years old; they will represent 9–10.5% of the population in those countries in 2050. Today, life expectancy at 80 years is, on average, 10 years for a woman and 7 years for a man in western countries (Health at a glance OECD indicators). This population is at high risk of cardiovascular disease (Assey, 1993). More specifically, aortic stenosis (AS) is the most frequent valvulopathy in adults ≥ 75 years old, being present in as many 4.6% (Nkomo et al., 2006). Progress made in anesthesia, surgery and intensive care explain why doctors, surgeons and cardiologists are less-and-less reluctant to propose aortic valve replacement (AVR) for older-and-older patients. However, for this very specific population, many questions remain to be answered before such surgery can be undertaken: What is the spontaneous evolution of the disease? Is there a therapeutic option other than surgery? What are the postoperative results in terms of morbidity and mortality? Will surgical treatment relieve the symptoms and improve the quality of life (QOL) at intermediate and long term? What are the complications and constraints associated with the prosthesis? Are those results universal? Will my patient become frail or disabled after surgery?