Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Abstract

long-term results Aortic valve surgery in octogenarians: predictive factors for operative and This information is current as of April 2, 2007http://ejcts.ctsnetjournals.org/cgi/content/full/31/4/600 located on the World Wide Web at:The online version of this article, along with updated information and services, is AbstractObjective: To assess factors influencing operative and long-term outcome in octogenarians undergoing aortic valve surgery (AVR). Methods: Records of 220 consecutive octogenarians having AVR between 1992 and 2004 were reviewed, and follow-up obtained (99% complete). Of the group (mean age: 82.8 years; 174 females), 142 patients (65%) were in New York Heart Association (NYHA) class III-IV, 22 (10%) had previous myocardial infarction, 11 (5%) had previous coronary artery bypass grafting (CABG), and 8 (4%) had percutaneous aortic valvuloplasty. There were 44 urgent procedures (20%), and additional CABG was performed in 58 patients (26%). Results: Operative mortality was 13% (9% for AVR, 24% for AVR + CABG). Among the 29 patients who died, 14 (48%) were operated on urgently (32% mortality for urgent procedures). Causes of hospital death were respiratory insufficiency or infection in 16 patients (16/29 = 55%), myocardial infarction in 8 (28%), stroke in 2 (7%), sepsis in 2 (7%), and renal failure in 1 (3%). Significant postoperative complications were atrial fibrillation in 48 patients (22%), respiratory insufficiency in 46 (21%), permanent atrio-ventricular bloc in 12 (5%), myocardial infarction in 10 (5%), hemodialysis in 4 (2%), and stroke in 4 (2%). Mean hospital and intensive care unit (ICU) stays were 17.6 AE 5.2 and 6.9 AE 3.4 days, respectively. Multivariate predictors ( p < 0.05) of hospital death were urgent procedure, associated CABG, NYHA class IV, and percutaneous aortic valvuloplasty. Age, associated CABG, and urgent procedure were predictors of prolonged ICU stay. Mean follow-up was 58.2 months and actuarial 5-year survival was 73.2 AE 6.9%. Age, preoperative myocardial infarction, urgent procedure, and duration of ICU stay were independent predictors of late death. Among 130 patients alive at follow-up, 91% were angina free and 81% in class I-II. Conclusions: AVR in octogenarians can be performed with acceptable mortality, although significant morbidity. These results stress the importance of early operation on elderly patients with aortic valve disease, avoiding urgent procedures. Associated coronary artery disease is a harbinger of poor operative outcome. Long-term survival and functional recovery are excellent. #

Implante transapical de valva aórtica: resultados de uma nova prótese brasileira

“…This procedure is well established in the literature and their results favorable and consistent, even in higher age groups and patients with multiple comorbidities [13][14][15].…”

Relationship Between Aortic Valve Replacement and Old Age

“…The mean NYHA classification of survivors fell from 3.1 to 1.7 (p<0.001) (Sundt et al, 2000). Lastly, 91% of survivors were angina-free (Kolh et al, 2007).…”

“…Postoperative mortality rates were higher when CABG was combined with AVR compared to AVR alone. However, the postoperative morbidity rate was very high for octogenarians after AVR (Melby et al, 2007;Thourani et al, 2008) and more than two-thirds of octogenarians will develop ≥1 postoperative complications (Collart et al, 2005;Kolh et al, 2007;Maillet et al, 2009 (16.7-35.7%), prolonged mechanical ventilation (≥24 hours) (22-26%), reoperation for bleeding (6-9%), permanent strokes (3-6%), acute renal failure (4.6-12%), infections (2.4-5.6%) and heart block requiring a pacemaker (2.3-5%) (Collart et al, 2005;Kohl et al, 2007;Melby et al 2007;Sundt et al, 2000;Thourani et al, 2008 1976-1987 1974-1987 1983-1986 1976-1988 1982-1986 1981-1989 1975-1991 1982-1992 1986-1995 1993-1998 1990-1993 1993-2003 1992-2003 1978-2003 2000-2004 1996-2003 1993-2005 1992-2004 1999-2003 1996-2006 1995-2006 1998-2003 1996-2006 2005-2007 (Collart et al, 2005;Kolh et al, 2007;Maillet et al, 2009,). The mean NYHA classification of survivors fell from 3.1 to 1.7 (p<0.001) (Sundt et al, 2000).…”

Quality of life among patients with severe aortic stenosis

“…Quality of life is of utmost importance for a patient, yet there is hardly any literature on this subject in patients with severe aortic stenosis. Although some retrospective studies report on functional status and QoL in patients after AVR, they are often troubled by several limitations [5,14,15,27]. Furthermore, these studies used patients with aortic stenosis who were referred (selected) for surgery.…”

“…Medical therapy does not slow the progression of severe aortic stenosis nor has it proven to reduce major adverse cardiac events; the only effective treatment is replacement of the aortic valve [1][2][3]. Surgical techniques and postoperative care have improved over the years and even patients with advanced age and comorbidities can be operated on relatively safely [4,5]. Recently, the indications for transcatheter valve implantations have been evaluated, which now form a treatment option in patients with high operative risk [6,7].…”