Proefschrift Jansen Klomp

General introduction and outline
To overcome the limitations of an observational study would require a randomized
diagnostic intervention study, in Chapter 6 we present the results of a pilot phase
of such a study. Patients were randomly allocated to a perioperative diagnostic protocol
with conventional TEE (control) or the addition of modified TEE (intervention).
The primary outcome was the incidence of new diffusion-weighted lesions on a
post-operative MRI. The aims of this pilot study were to assess the feasibility of our
study design, and to estimate the incidence of the primary end-point.
The introduction of percutaneous options for aortic valve replacement introduced
questions regarding the optimal approach in patients with symptomatic aortic stenosis.
Severe aortic atherosclerosis is a well established reason for a percutaneous
approach. From registry data it is known that advanced age is also a frequent reason
for a transcatheter, rather than a surgical approach; this indication is however not
established in guidelines. In Chapter 7 we studied the outcomes after aortic valve
replacement for aortic stenosis in patients aged >80 (octogenarians). Aortic valve
replacement is known to improve the survival of patients with aortic stenosis, but in
elderly patients an improvement in the quality of life may be of greater relevance.
We compared the incidence of post-operative complications, changes in the qualityof-life
and the long-term survival in octogenarians, and compared these outcomes
with patients aged