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lüll To operate or not on elderly patients with aortic stenosis: the decision and its consequences Bouma BJ; van Den Brink RB; van Der Meulen JH; Verheul HA; Cheriex EC; Hamer HP; Dekker E; Lie KI; Tijssen JGHeart 1999[Aug]; 82 (2): 143-8OBJECTIVE: To evaluate the application of guidelines in the decision making process leading to medical or surgical treatment for aortic stenosis in elderly patients. DESIGN: Cohort analysis based on a prospective inclusive registry. SETTING: 205 consecutive patients (>/= 70 years) with clinically relevant isolated aortic stenosis and without serious comorbidity, seen for the first time in the Doppler-echocardiographic laboratories of three university hospitals in the Netherlands. RESULTS: The initial choice was surgery in 94 patients and medical treatment in 111. Only 59% of the patients who should have had valve replacement according to the practice guidelines were actually offered surgical treatment. These were mainly symptomatic patients under 80 years of age with a high gradient. Operative mortality (30 days) was only 2%. The three year survival was 80% in the surgical group (17 deaths among 94 patients) and 49% in the medical group (43/111). Multivariate analysis showed that only patients with a high baseline risk, mainly determined by impaired left ventricular function, had a significantly better three year survival with surgical treatment than with medical treatment. CONCLUSIONS: In daily practice, elderly patients with clinically relevant symptomatic aortic stenosis are often denied surgical treatment. This study indicates that a surgical approach, especially where there is impaired systolic left ventricular function, is associated with better survival.|*Heart Valve Prosthesis Implantation/mortality[MESH]|*Patient Selection[MESH]|Age Factors[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Aortic Valve Stenosis/drug therapy/mortality/*surgery[MESH]|Aortic Valve/*surgery[MESH]|Evaluation Studies as Topic[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Multivariate Analysis[MESH]|Practice Guidelines as Topic[MESH]|Prospective Studies[MESH]|Survival Rate[MESH] |