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Aortic valve replacement with and without combined coronary bypass grafts in very elderly patients: early and long-term results.
MedLine Citation:
PMID:  22345174     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE The number of older patients being referred for aortic valve replacement with or without combined coronary bypass grafting (CABG) is increasing. The aim of this study was to evaluate operative risk factors, early and long-term results of isolated aortic valve and aortic valve replacement combined with CABG in octogenarians and nonagenarians. METHODS In the last 10 years, 285 very elderly patients who underwent aortic valve replacement either alone or in combination with coronary artery bypass grafts were retrospectively studied. The population was divided into two groups; isolated aortic valve replacement was performed in 188 patients (group A) and 97 patients had aortic valve replacement combined with coronary surgery (group B). RESULTS The overall hospital mortality was 5.3%, without statistical difference between groups. The incidence of low-output syndrome was higher in group B (P = 0.0001). The multivariate analysis for hospital mortality showed that urgency status, ejection fraction (EF)  <35%, intra-operative variables such as clamping time, need for intra aortic balloon pump and post-operative variables such as prolonged ventilation, dialysis, post-operative myocardial infarction and re-thoracotomy for bleeding were independent prognostic factors for hospital mortality. The mean follow-up time was 49.03 ± 19 months. Survival at one, three and five years was 97.1 ± 1.8%, 92.2 ± 2.2% and 82.4 ± 3.6% for group A and 97.2 ± 2.0%, 88.4 ± 2.7% and 75.6 ± 3.2% for group B (P = 0.62), respectively. Age, male gender, post-operative myocardial infarction, urgency status, dialysis, low EF, mean aortic gradient were risk factors for the impaired survival. CONCLUSIONS In our experience, a careful pre-operative evaluation has yielded good surgical results even in older patients with different comorbidities. Associated coronary grafts slightly increase the surgical risk. The role of revascularization on long-term morbidity and mortality is still not clear. It is essential to compare the results of percutaneous and trans-apical aortic valve replacement with the literature results of conventional aortic valve replacement with and without CABG before it can be used as an alternative for very older patients.
Authors:
Andrea Dell'amore; Tommaso Maria Aquino; Marco Pagliaro; Mauro Lamarra; Claudio Zussa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  41     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  491-8     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, Villa Maria Cecilia GVM Hospital for Care and Research, Cotignola, Lugo (RA), Italy.
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