Document Detail


Aortic valve replacement in octogenarians: analysis of risk factors for early and late mortality.
MedLine Citation:
PMID:  21053741     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM OF THE STUDY: Cardiac surgery can be performed on elderly patients in good physical and mental health, thus improving their mortality, morbidity, and quality of life. Nevertheless, for some elderly patients aortic valve replacement (AVR) is still denied because of the presence of preoperative characteristics, such as older age and left ventricular dysfunction. The study aim was to review early and long-term results in patients aged > or = 80 years who underwent AVR for severe aortic stenosis, and to identify risk factors for in-hospital and late mortality.
METHODS: A total of 165 patients (mean age 82 +/- 2.1 years) underwent AVR for severe aortic stenosis, with or without concomitant coronary revascularization, at the authors' institution. The mean aortic valve area was 0.61 +/- 0.2 cm2. Preoperatively, 20 patients (12%) had a left ventricular ejection fraction < 35%. The mean EuroSCORE was 9.45 +/- 1.52.
RESULTS: Seven patients (4%) experienced low cardiac output syndrome, and acute renal failure occurred in 24. No perioperative myocardial infarction, stroke or sternal wound infection was detected. In total, 23 patients (14%) required prolonged ventilatory support. The in-hospital mortality was 3%. After a mean follow up of 43 +/- 35.6 months there were 18 late deaths: the cardiac-related mortality was 7%. The mean NYHA class was improved from 2.86 +/- 0.67 to 1.44 +/- 0.57 (p < 0.0001).
CONCLUSION: Conventional AVR remains the standard of care, and can be performed with satisfactory in-hospital mortality, long-term life expectancy and quality of life in high-risk elderly patients. Although the transcatheter aortic valve technique seems to be a promising option, its long-term value must be established in prospective, randomized trials.
Authors:
Francesco Nicolini; Cesare Beghi; Fabio Barbieri; Piercesare Secchi; Andrea Agostinelli; Claudio Fragnito; Igino Spaggiari; Tiziano Gherli
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  19     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-11-08     Completed Date:  2010-12-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  615-22     Citation Subset:  IM    
Affiliation:
Heart Surgery Section, Department of Surgical Sciences, University of Parma Medical School, Parma, Italy. francesco.nicolini@unipr.it
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged, 80 and over
Aortic Valve / surgery*
Aortic Valve Stenosis / mortality*,  surgery*
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation*
Hospital Mortality
Humans
Male
Retrospective Studies
Risk Factors
Survival Rate

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


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