Contemporary outcomes of conventional aortic valve replacement in 638 octogenarians: insights from an Italian Regional Cardiac Surgery Registry (RERIC)

Eusanio, Marco Di; Fortuna, Daniela; Cristell, Donald; Pugliese, Peppino; Nicolini, Francesco; Pacini, Davide; Gabbieri, Davide; Lamarra, Mauro

doi:10.1093/ejcts/ezr204

Cited by 43 publications

(37 citation statements)

References 24 publications

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“…Recent observational studies have demonstrated that elderly patients or those with depressed left ventricular function or affected by systemic coexisting disorders are at increased risk for operative mortality or morbidity. 5,[9][10][11][12][13] To cast further light on these issues, we conducted this registry study reporting outcomes from a large regional series of high-risk patients undergoing SAVR, with or without associated coronary artery bypass grafting (CABG) from 2008 through 2013 in Emilia Romagna (ER), Italy. The main purpose was to assess 30-day mortality and morbidity, and 5-year outcomes (all-cause mortality, cardiac related death, stroke, re-operation, definitive pacemaker implantation); the second aim was to identify and discuss the potential risk factors for increased early and late mortality.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?

Nicolini

Fortuna

Contini

et al. 2016

ATCS

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Purpose: The introduction of transcatheter aortic valves has focused attention on the results of conventional aortic valve surgery in high-risk patients. The aim of the study was to evaluate 5-years outcomes in this category of patients in the current surgical era. Methods: This is an observational retrospective study of 581 high-risk patients undergoing aortic valve replacement from 2008 to 2013, with a mean logistic EuroSCORE of 26.6% ± 14.6%. Data were prospectively collected in a database of Emilia-Romagna region (Italy). Results: Overall 30-day mortality was 9.3%. Stroke rate was 1.5%. At 1-, 3-, and 5-years overall mortality was 18.2%, 30.4%, and 42.2%, cardiac death rate was 3.9%, 9.2%, and 12.9%, stroke rate 2.5%, 7.7%, and 10.2%, re-operation occurrence 0.2%, 0.9% and 1.3%, and new pacemaker implantation was 2.3%, 5.1% and 7.8%. At multivariate analysis, urgency, hemodynamic instability, LVEF ≤30%, NYHA III-IV, severe chronic obstructive pulmonary disease (COPD), extra-cardiac arteriopathy, cerebrovascular disease, and creatinine >2.0 mg/dL remained independent predictors of 5-year mortality. Conclusion: The results of the current study add weight to the evidence that traditional aortic valve replacement can be performed in high-risk patients with satisfactory 5-year mortality and morbidity. Our study may help to improve decision-making in this category of high-risk patients with aortic valve disease.

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Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?

Nicolini

Fortuna

Contini

et al. 2016

ATCS

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“…26 More recently, Di Eusanio et al reported 4.5% operative mortality in a large regional series of 638 octogenarians undergoing isolated AVR surgery, with a mean logistic EuroSCORE I of 13.0%±7.9, very similar to our results. 12 In another large series, Saxena et al reported a 4.0% 30-day mortality rate in 531 octogenarians undergoing isolated AVR surgery. Although no formal surgical risk score calculation was mentioned, precluding a more accurate comparison, these results are also in agreement with the present series.…”

Section: Operative Resultsmentioning

confidence: 96%

Aortic valve replacement for severe aortic stenosis in octogenarians: Patient outcomes and comparison of operative risk scores

Tralhão

Teles

Almeida

et al. 2015

Revista Portuguesa de Cardiologia

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“…In our Center, in 2010-2012, TAVI was performed in 73 patients aged 76 ± 9 (52-90), in 51% of men and 49% of women, with a mortality rate of 3.4%. By contrast, the number of deaths after surgical valve replacement in patients aged ≥75 was as high as 21.9% (8)(9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

“…In such cases, OPCAB should be opted for, thus avoiding a number of complications. Increasingly frequently, older patients undergo hybrid surgery which consists in combining surgical techniques with catheterization (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Nursing risk assessment of postoperative complications in patients aged over 75, qualified for cardiosurgery operations

2017

IJND

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Abstract:Aim: The aim of the work was to assess the risk of postoperative complications in patients aged over and under 75 undergoing cardiac surgery, with a view to optimize perioperative care and minimize the incidence of complications. Material and methods: The retrospective study encompassed n=5,419 patients (1,822 women and 3,597 men), aged 16-103 (mean 63.3±11.6) who underwent surgery between 2010 and 2014. The patients were divided into: Group1 <75, n=4,583 (1,429 women and 3,154 men), aged 16-74 (mean 60.6 ±10.5) and Group2 ≥75, n=836 (393 women and 443 men), aged 75-103 (mean 78±3.0). The prevalence of cardiac and noncardiac diseases in both groups was comparable. Results: The following, statistically significant postoperative complications were observed in Group ≥ 75: neurological (14.4%), predominantly psychosis (8,1%); renal (11.4%) with creatinine increase >200mg% (9.5%); pulmonary (11.4%) with pleural fluid evacuation (6.3%); reoperation (10.4%), mainly due to haemorrhage (5.6%), and gastrointestinal tract dysfunction, including intra-intestinal nutrition (9.7%). Conclusions:1. In patients> 75 years of age eligible for cardiac surgery, co-morbidity often occurs. 2. Age, however, is not a contraindication for cardiac surgery, although it is an important risk factor for mortality and postoperative complications. 3. Cardiac surgery for patients over 75 years of age is subject to a perioperative risk rating.

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Contemporary outcomes of conventional aortic valve replacement in 638 octogenarians: insights from an Italian Regional Cardiac Surgery Registry (RERIC)

Abstract: This study, showing that contemporary outcomes after AVR are excellent, may help to improve treatment decision-making in elderly patients with aortic valve disease.

Cited by 43 publications

References 24 publications

Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?

Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?

Aortic valve replacement for severe aortic stenosis in octogenarians: Patient outcomes and comparison of operative risk scores

Nursing risk assessment of postoperative complications in patients aged over 75, qualified for cardiosurgery operations

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