Aortic stenosis and the elderly

Grinberg, Max; Solimene, Maria Cecilia

doi:10.1590/S0066-782X2011000100015

Aortic valve stenosis; aged

LETTER TO THE EDITOR

Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil

Mailing address

Keywords: Aortic valve stenosis; aged.

Dear Editor,

Valle et al¹ focus on a topic that has started to arouse interest in Brazil, not only due to the increase in the population of elderly people among us², but also because, according to the Euro Heart Survey, medical services have denied valvular surgery to a significant percentage of elderly patients on the basis of age³. The mortality rate of patients aged 75 years or more in 230 consecutive surgical procedures to correct aortic stenosis, in a period of 6 years, was 13.9% (9.4% of which occurred in isolated procedures and 20.9% in associations). Non-fatal complications appeared in 30% of the cases (25.2% of which occurred in patients with isolated aortic stenosis and 37.4% in associations)¹. These data are similar to those of the literature. The authors concluded that the morbidity-mortality after the surgical procedure to correct aortic stenosis is "slightly higher" among the elderly than among "younger people". The matter deserves further consideration, since there is some dissociation between the methods and the conclusion: 1) The authors concluded that the morbidity-mortality of the elderly is "slightly higher" than that of younger people, but they did not analyze a group of "young people" for comparison purposes and they did not refer to literature data, either; 2) There are semantics and interpretation issues that put the reader in doubt, as, for example, the vagueness of the expression "slightly higher" for morbidity and mortality; 3) The term "elderly" does not seem appropriate, since "the elderly" are defined as those individuals aged 60 years or more; It would be more appropriate to refer specifically to those above 75 years of age. As there is not enough time to go over the avalanche of scientific information, the Conclusion is used for screening purposes and as memory reference. That is why it is an important factor in the communication between author and reader and, as such, it has to be in perfect harmony with the purpose and method. The results obtained by Valle et al¹ are useful for the daily work of clinics, to be applied to patients with aortic stenosis. However, most readers that rely on abstracts to learn run the risk of memorizing incorrect information.

References

1. Valle FH, Costa AR, Pereira EMC, Santos EZ, Pivatto Junior F, Bender LP et al. Morbimortalidade em pacientes acima de 75 anos submetidos à cirurgia por estenose valvar aórtica. Arq Bras Cardiol. 2010;94(6):720-5.
2. Grinberg M, Accorsi TAD. Estenose aórtica no idoso: perspectiva brasileira. Arq Bras Cardiol. 2009;92(2):e36-9.
3. Iung B, Baron G, Tornos P, Gohlke-Bärwolf C, Butchart EG, Vahanian A. Valvular heart disease in the community: a European experience. Curr Probl Cardiol. 2007;32(11):609-61.