Article Text

Surgery for aortic stenosis in severely symptomatic patients older than 80 years: experience in a single UK centre
  1. OMP JOLOBE
  1. Department of Medicine for the Elderly
  2. Tameside General Hospital
  3. Fountain Street
  4. Ashton under Lyne, OL6 9RW, UK

    Statistics from Altmetric.com

    Editor,—There are limitations to the use of increases in serum creatinine as a marker indicative of early postoperative death,1, not least because derangement in this parameter may have more to do with injudicious diuretic dosage in the presence of the unique co-existence of diastolic left ventricular failure and left ventricular outflow obstruction. The use of diuretics for antifailure treatment may, in this context (as in other conditions characterised by diastolic failure), impair the left ventricular filling to such an extent as to precipitate a low output state,2 one consequence being the development of prerenal uraemia. Therefore, if anything, the onset of deterioration in renal function should initiate a shift from medical treatment to surgical intervention, coupled with an interim reduction in diuretic dosage. Surprisingly, notwithstanding the acknowledgement of the existence of an aortic stenosis related syndrome of low output failure (characterised by pronounced fatigue and debilitation),3there is little or no documentation that one of its manifestations could be the syndrome of “aggravated renal dysfunction during intensive treatment for advanced chronic heart failure”.4

    References

    View Abstract

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.