Document Detail


Valve surgery in octogenarians: in-hospital and long-term outcomes.
MedLine Citation:
PMID:  17347695     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Global population aging and greater age-related incidence of ischemic, degenerative and calcific valve disease have led to an increasing number of very elderly patients being referred for valve surgery. However, their preoperative risk factors, and in-hospital and long-term outcomes have not been thoroughly investigated. METHODS: Three hundred seven consecutive patients 80 years and older (60% female; mean age 83+/-2.4 years) attending three major Italian cardiac centres to undergo valve surgery were evaluated. Seventy-nine patients underwent mitral valve surgery (isolated n=30, combined n=49) and 228 underwent aortic valve surgery (isolated n=134, combined n=94). RESULTS: The most frequent in-hospital complications were atrial arrhythmias, need for inotropic support for more than 48 h, renal insufficiency, congestive heart failure, respiratory failure, and stroke or transient ischemic attack. The in-hospital mortality rate was 9.7% (30 of 307). Multivariate logistic regression identified the following clinical variables as predictors of in-hospital death: New York Heart Association functional class IV, diabetes, hypertension, renal insufficiency at presentation, rheumatic etiology and left ventricular ejection fraction of less than 45%. Late mortality occurred in 45 of 277 patients (16.2%), but there was a substantial improvement in the New York Heart Association functional class of the 232 long-term survivors (from 3.0+/-0.7 to 1.7+/-0.6; P<0.0001). CONCLUSIONS: Surgery seems to be an effective therapeutic option for selected symptomatic octogenarians with valve disease, associated with good long-term survival and an improved functional class. Operative mortality is related more to patients' preoperative clinical status and increased comorbidity than the type of surgery per se.
Authors:
Eduardo Bossone; Giuseppe Di Benedetto; Alessandro Frigiola; Giannignazio Luigi Carbone; Antonello Panza; Silvia Cirri; Andrea Ballotta; Stefano Messina; Saverio Rega; Rodolfo Citro; Santi Trimarchi; Jianming Fang; Paolo Righini; Alessandro Distante; Kim A Eagle; Rajendra H Mehta
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  23     ISSN:  0828-282X     ISO Abbreviation:  Can J Cardiol     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-09     Completed Date:  2007-04-20     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  223-7     Citation Subset:  IM    
Affiliation:
Institute of Clinical Physiology, National Research Council of Italy, Lecce Section. ebossone@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged, 80 and over
Aortic Valve / surgery*
Female
Follow-Up Studies
Heart Valve Diseases / mortality*,  surgery*
Heart Valve Prosthesis Implantation* / adverse effects,  mortality
Hospital Mortality*
Humans
Italy / epidemiology
Logistic Models
Male
Mitral Valve / surgery*
Multivariate Analysis
Postoperative Complications / etiology,  mortality
Predictive Value of Tests
Survival Rate
Time Factors
Treatment Outcome
Tricuspid Valve / surgery
Comments/Corrections

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


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