Document Detail


Aortic valve replacement in octogenarians: is biologic valve the unique solution?
MedLine Citation:
PMID:  18355513     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: This study analyzed morbidity, mortality, and quality of life after aortic valve replacement with mechanical and biologic prostheses in octogenarian patients. METHODS: A retrospective analysis was performed in 345 consecutive patients, mean age of 82 +/- 2 years (range, 80 to 92), who had aortic valve replacement from May 1991 to April 2005. A bioprosthesis (group I) was used in 200 patients (58%), and 145 (42%) received a mechanical prosthesis (group II). Associated cardiac procedures were done in 211 patients (61%), of which 71% were coronary artery bypass grafting. Patients had symptomatic aortic stenosis (84.3%) or associated aortic insufficiency; 88% were in New York Heart Association (NYHA) class III or IV. The mean preoperative aortic valve gradient was 62 +/- 16 mm Hg (range, 25 to 122 mm Hg). The mean left ventricular ejection fraction was good (0.52 +/- 0.12); 30 patients (8.7%) had an ejection fraction of less than 0.30. RESULTS: The in-hospital mortality rate was 7.5% (26 patients); 17 (8.5%) in group I and 9 (6.2%) in group II (p = 0.536) Significant predictors of operative mortality were preoperative renal insufficiency (blood creatinine > 2.00 mg/mL) and need for urgent operation. Mean follow-up, complete at 100%, was 40 +/- 33 months (range, 1 to 176 months). Long-term follow-up, using Kaplan-Meier analysis, showed an overall survival of 61% at 5 years and 21% at 10 years; survival by type of prosthesis was significantly higher with mechanical prostheses (log-rank p = 0.03). Freedom from cerebrovascular events (thromboembolic/hemorrhagic) at 5 and 10 years was 89% and 62% in the mechanical group and 92% and 77% in the biologic group (p = 0.76). Postoperative NYHA functional class was I or II in 96% of patients. Quality-of-life scores were excellent considering the age of the patients. No differences were found between the two groups. CONCLUSIONS: Surgical treatment for symptomatic aortic stenosis in octogenarians has an acceptable operative risk with excellent long-term results and good quality of life. In this cohort, survival rate is slightly but significantly higher with mechanical prostheses.
Authors:
Carlo de Vincentiis; Alessia B Kunkl; Santi Trimarchi; Piervincenzo Gagliardotto; Alessandro Frigiola; Lorenzo Menicanti; Marisa Di Donato
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  85     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-21     Completed Date:  2008-04-16     Revised Date:  2009-01-22    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1296-301     Citation Subset:  AIM; IM    
Affiliation:
Cardiac Surgery Department, San Donato Hospital, Milan, Italy.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged, 80 and over
Aortic Valve Insufficiency / mortality,  surgery*,  ultrasonography
Bioprosthesis*
Cause of Death*
Cohort Studies
Echocardiography, Doppler
Female
Follow-Up Studies
Geriatric Assessment
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation / adverse effects,  methods,  mortality*
Hospital Mortality / trends
Humans
Kaplan-Meiers Estimate
Logistic Models
Male
Multivariate Analysis
Postoperative Complications / mortality
Probability
Prosthesis Design
Prosthesis Failure
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Survival Analysis
Time Factors
Comments/Corrections
Comment In:
Ann Thorac Surg. 2009 Jan;87(1):350-1; author reply 351   [PMID:  19101340 ]
Ann Thorac Surg. 2008 Apr;85(4):1301-2   [PMID:  18355514 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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