INTRODUCTION AND OBJECTIVES: Greater life-expectancy has led to an increase in the incidence of severe aortic stenosis, which accounts for a significant proportion of the workload of cardiology departments. With the imminent arrival of percutaneous aortic valve prostheses, it is important to know how effective surgery currently is in octogenarians. METHODS: The study included all patients aged >or=80 years with severe aortic stenosis who underwent cardiac catheterization prior to aortic valve replacement between May 1996 and May 2006. The percentage of patients who underwent surgery, outcomes at 30 days, long-term survival, and predictors of mortality were analyzed. RESULTS: Of the 137 patients evaluated, 104 (75.9%) underwent surgery, while 33 did not due to a low ejection fraction or severe chronic bronchitis, or because the patient's family did not give consent. The patients' mean age was 81.7 (1.5) years, 61.5% were female, 18.4% had diabetes, 7.8% had had a previous infarction, and 32.7% had coronary disease. Three patients (2.9%) had a perioperative myocardial infarction, six (5.8%) had a stroke, and six (5.8%) had a permanent pacemaker. Four patients (3.8%) died during the first 30 days. The survival rates at 1, 2, 3, 4, 5 and 6 years were 90 (2.9), 81 (4.2), 78 (4.8), 75 (5.3), 65 (7.2) and 60 (8.2)%, respectively. The following predictors of long-term mortality were identified: creatinine level, emergency surgery, and reintervention because of bleeding. Some 76.3% of patients remained in New York Heart Association functional class I-IV. CONCLUSIONS: Aortic valve replacement can be performed successfully in patients aged >or=80 years with severe aortic stenosis; the complication rate was low, and the survival rate and long-term results were good. Predictors of mortality in this series were the creatinine level, emergency surgery, and reintervention because of bleeding.
INTRODUCTION AND OBJECTIVES: Greater life-expectancy has led to an increase in the incidence of severe aortic stenosis, which accounts for a significant proportion of the workload of cardiology departments. With the imminent arrival of percutaneous aortic valve prostheses, it is important to know how effective surgery currently is in octogenarians. METHODS: The study included all patients aged >or=80 years with severe aortic stenosis who underwent cardiac catheterization prior to aortic valve replacement between May 1996 and May 2006. The percentage of patients who underwent surgery, outcomes at 30 days, long-term survival, and predictors of mortality were analyzed. RESULTS: Of the 137 patients evaluated, 104 (75.9%) underwent surgery, while 33 did not due to a low ejection fraction or severe chronic bronchitis, or because the patient's family did not give consent. The patients' mean age was 81.7 (1.5) years, 61.5% were female, 18.4% had diabetes, 7.8% had had a previous infarction, and 32.7% had coronary disease. Three patients (2.9%) had a perioperative myocardial infarction, six (5.8%) had a stroke, and six (5.8%) had a permanent pacemaker. Four patients (3.8%) died during the first 30 days. The survival rates at 1, 2, 3, 4, 5 and 6 years were 90 (2.9), 81 (4.2), 78 (4.8), 75 (5.3), 65 (7.2) and 60 (8.2)%, respectively. The following predictors of long-term mortality were identified: creatinine level, emergency surgery, and reintervention because of bleeding. Some 76.3% of patients remained in New York Heart Association functional class I-IV. CONCLUSIONS: Aortic valve replacement can be performed successfully in patients aged >or=80 years with severe aortic stenosis; the complication rate was low, and the survival rate and long-term results were good. Predictors of mortality in this series were the creatinine level, emergency surgery, and reintervention because of bleeding.
Authors: Alex Zapolanski; Andrew W C Mak; Giovanni Ferrari; Christopher Johnson; Richard E Shaw; Mariano E Brizzio; Jason S Sperling; Juan B Grau Journal: Interact Cardiovasc Thorac Surg Date: 2012-06-04