Long-Term Survival of the Very Elderly Undergoing Aortic Valve Surgery

Abstract

Background— Increasing numbers of the very elderly are undergoing aortic valve procedures. We describe the short- and long-term survivorship for this cohort. Methods and Results— We conducted a cohort study of 7584 consecutive patients undergoing open aortic valve surgery without (51.1%; AVR) or with (48.9%; AVR + CABG) concomitant coronary artery bypass graft surgery between November 10, 1987 through June 30, 2006. Patient records were linked to the Social Security Administration’s Death Master File. Survivorship was stratified by age and concomitant CABG surgery. During 39 835 person-years of follow-up, there were 2877 deaths. Among AVR, there were 3304 patients <80 years of age, 419 patients 80 to 84 years, and 156 patients ≥85 years (24 patients >90 years). Among AVR+CABG patients, there were 2890 patients <80 years of age, 577 patients 80 to 84 years, and 238 patients ≥85 years (22 patients >90 years). Median survivorship for patients undergoing isolated AVR was 11.5 years (<80 years), 6.8 years (80 to 84 years), 6.2 years (≥85 years); for patients undergoing AVR+CABG, median survivorship was 9.4 years (<80 years), 6.8 years (80 to 84 years), and 7.1 years (≥85 years). Among both procedures, adjusted survivorship was significantly different across strata of age ( P <0.001). These findings are similar to life expectancy of the general population from actuarial tables: 80 to 84 years (7 years) and ≥85 years (5 years). Conclusions— Survivorship among octogenarians is favorable, with more than half the patients surviving more than 6 years after their surgery. Concomitant CABG surgery does not diminish median survivorship among patients >80 years of age.

The economic value of rapid deployment aortic valve replacement via full sternotomy

“…The change in life years was estimated as the difference in mortality rate between EIE-FS-RDAVR and FS-AVR multiplied by the life expectancy of the individual. Consistent with a previous analysis, we assumed an average life expectancy of 11 years for surgical AVR individuals in this population [42,43]. The Likosky study, besides finding comparable long-term survivorships between AVR patients and a general population of similar age, also found that this survival varied little and was not contingent on the type of AVR surgery.…”

“…Its prevalence increases with age, from 2.5% at 75 years to 8.1% at 85 years [46]. Left untreated, disease progression is rapid and fatal with a mean survival time of only 1.5-3 years past diagnosis [42]. Elective FS-AVR performed through FS has been deemed a safe procedure since it carries low morbidity and short/long-term mortality rates.…”

“…Elective FS-AVR performed through FS has been deemed a safe procedure since it carries low morbidity and short/long-term mortality rates. Specifically, multiple studies found AVR to be associated with favorable long-term survivorship, with average times ranging between 6.2 and 11.2 years postsurgery depending on age [42,47]. As such, AVR (isolated or concomitant with coronary Table 2.…”

Aortic Valve Replacement with and without Coronary Artery Bypass Graft Surgery in Octogenarians: Is It Safe and Feasible?

“…Gulbins et al [18 ]also observed higher mortality rates in patients undergoing AVR/CABG compared to those undergoing either AVR or CABG alone, concluding that the additional risk of mortality was real, but actually lower than that predicted, based on the EuroSCORE. Although combined AVR and CABG does carry with it a significantly higher mortality risk in the immediate postoperative period, this appears primarily related to the increased complexity of the procedure rather than something intrinsic to the patient selection process, as similar preoperative comorbidities and postoperative complications have been present in patients undergoing AVR alone, CABG alone or combined procedures (table 7) [9,17]. …”

Comparison of mid-term results of transcatheter aortic valve implantation in high-risk patients with logistic EuroSCORE ≥ 20% or < 20%

“…Increasing use of TAVI in older moderate risk patients is based on registry data showing that outcomes of TAVI in moderate risk patients are superior compared to those in high surgical risk patients [3,[16][17][18]. It is also known that surgical outcomes in older patients are worse than in younger patients [19,20]. Recently, a randomised trial Figure 1.…”