[en] OBJECTIVES: To determine long-term results of aortic valve replacement (AVR) in patients 80 years old or older, and assess the factors influencing perioperative outcome. METHODS: Data were reviewed on 83 consecutive octogenarians, undergoing aortic valve replacement between 1992 and 1997. There were 66 women and 17 men (mean age: 82.8 years). Fifty-seven patients (69%) were in New York Heart Association (NYHA) class III-IV and six had previous myocardial infarction. Three patients had previous percutaneous aortic valvuloplasty. There were 19 urgent procedures (23%). Coronary artery bypass grafting (CABG) was performed on 21 patients (25%). Possible influence of preoperative and operative variables on early and late mortality was performed with univariate and multivariate statistical analysis, and survival was estimated with the Kaplan-Meier method. RESULTS: Operative mortality was 13% (9% for AVR, 24% for AVR-CABG). Postoperative complications were respiratory failure in 19 patients, atrial fibrillation in 19, hemodialysis in four, myocardial infarction in four and stroke in two patients. Five patients required pacemaker insertion for permanent atrioventricular block. Median hospital stay and intensive care unit stay were 19.8 +/- 12.2 days and 7.9 +/- 3.4 days, respectively. Multivariate predictors of hospital death (P < 0.05) were percutaneous aortic valvuloplasty, NYHA class IV, and urgent procedure. Mean follow-up was 26.5 months. Survival at 1, 2, and 5 years was 98.5 +/- 1.4% (63 patients at risk), 93.4 +/- 3.2% (47 patients at risk), and 78.2 +/- 6.9% (six patients at risk), respectively. Preoperative myocardial infarction and urgent procedure were independent predictors of late death. At most recent follow-up, 91% were angina free and 81% were in class I-II. CONCLUSIONS: Aortic valve replacement in octogenarians can be performed with acceptable mortality. These results stress the importance of early operation on elderly patients with aortic valve disease. Both long-term survival and functional recovery are excellent.
Disciplines :
Surgery Cardiovascular & respiratory systems
Author, co-author :
Kolh, Philippe ; Université de Liège - ULiège > Département des sciences cliniques > Chirurgie cardio-vasculaire et thoracique
Lahaye, Laurent; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie cardio-vasculaire
Gérard, Paul ; Université de Liège - ULiège > Département de mathématique > Statistique (aspects expérimentaux)
Limet, Raymond ; Université de Liège - ULiège > Département des sciences cliniques > Chirurgie cardio-vasculaire et thoracique
Language :
English
Title :
Aortic Valve Replacement in the Octogenarians: Perioperative Outcome and Clinical Follow-Up
Statistical Abstract of the United States: 1991 (111th Ed). Washington DC, Department of Commerce, US Bureau of the Census, 1991:81.
Roger V., Tajik A., Reeder G., Hayes S.N., Mullany C.J., Bailey K.R., Seward J.B. Effect of Doppler echocardiography on utilization of hemodynamic cardiac catheterization in the preoperative evaluation of aortic stenosis. Mayo Clin Proc. 71:1996;141-149.
Freeman W.K., Schaff H.V., O'Brien P.C., Orszulak T.A., Naessens J.M., Tajik A.J. Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol. 18:1991;29-35.
Tsai T.P., Nessim S., Kass R.M., Chaux A., Gray R.J., Khan S.S., Blanche C., Utley C., Matloff J.M. Morbidity and mortality after coronary artery bypass in octogenarians. Ann Thorac Surg. 51:1991;983-986.
Culliford A.T., Galloway A.C., Colvin S., Grossi E.A., Baumann F.G., Esposito R., Ribakove G.H., Spencer F.C. Aortic valve replacement for aortic stenosis in patients aged 80 years and over. Am J Cardiol. 67:1991;1256-1260.
Kleikamp G., Minami K., Breymann T., Samar U., Luth J.U., Reichelt W., Gleichmann U., Körfer R. Aortic valve replacement in octogenarians. J Heart Valve Dis. 1:1992;196-200.
Statistical Abstract of the United States: 1994 (114th Ed). Washington DC, Department of Commerce, US Bureau of the Census, 1994:84.
Iskandrian A.S., Segal B.L. Should cardiac surgery be performed in octogenarians? J Am Coll Cardiol. 18:1991;36-37.
Culliford A.T., Galloway A.C., Colvin S. Cardiac surgery in octogenarians: do the risks exceed the benefit? Am J Geriatr Cardiol. 1:1992;15-25.
Frank S., Johnson A., Ross J. Natural history of valvular aortic stenosis. Br Heart J. 35:1973;41-46.
Cribier A., Savin T., Saoudi N., Rocha P., Berland J., Letac B. Percutaneous transluminal valvuloplasty of acquired aortic stenosis in elderly patients: an alternative to valve replacement. Lancet. 330:1986;63-67.
McKay R.G. Balloon aortic valvuloplasty in 285 patients: initial results and complications. Circulation. 78(Suppl. 2):1988;594.
Robicsek F., Harbold N.B.J., Daugherty H.K., Cook J.W., Selle J.G., Hess P.J., Gallagher J.J. Balloon valvuloplasty in calcified aortic stenosis: a cause for caution and alarm. Ann Thorac Surg. 45:1988;515-525.
Akins C.W., Daggett W.M., Vlahakes G.J., Hilgenberg A.D., Torchiana D.F., Madsen J.C., Buckley M.J. Cardiac operations in patients 80 years old and older. Ann Thorac Surg. 64:1997;606-615.
Elayada M.A., Hall R.J., Reul R.M., Alonzo D.M., Gillette N., Reul G.J. Jr, Cooley D.A. Aortic valve replacement in patients 80 years and older: operative risks and long-term results. Circulation. 88(Part II):1993;11-16.
Tseng E.E., Lee C.A., Cameron D.E., Stuart R.S., Greene P.S., Sussman M.S., Watkins L., Gardner T.J., Baumgartner W.A. Aortic valve replacement in the elderly: risk factors and long-term results. Ann Surg. 225:1997;793-804.
Galloway A.C., Solvin S.B., Grossi E.A., Baumann F.G., Sabban Y.P., Esposito R., Ribakove G.H., Culliford A.T., Slater J.N., Glassman E., Harty S., Spencer F.C. Ten-year experience with aortic valve replacement in 482 patients 70 years of age or older: operative risk and long-term results. Ann Thorac Surg. 49:1990;84-93.
Straumann E., Kiowski W., Langer I., Grädel E., Stulz P., Buckhardt D., Pfisterer M., Burkart F. Aortic valve replacement in elderly patients with aortic stenosis. Br Heart J. 71:1994;449-453.
Chocron S., Etievent J.P., Viel J.F., Meneveau N., Clement F., Schipman N., Taberlet C., Alman K. Aortic valve replacement in the elderly: a comparative assay of potential risk factor modification. J Heart Valve Dis. 4:1995;268-273.
Jamieson W., Burr L.H., Munro A.I., Miyagishima R.T., Gerein A.N. Cardiac valve performance in the elderly: clinical performance of biologic prostheses. Ann Thorac Surg. 48:1989;173-185.
Borkon A.M., Soule L.M., Baughman K.L., Baumgartner W.A., Gardner T.J., Watkins L., Gott V.L., Hall K.A., Reitz B.A. Aortic valve selection in the elderly patient. Ann Thorac Surg. 46:1988;270-277.
Fiore A.C., Naunheim K.S., Barner H.B., Pennington D.G., McBride L.R., Kaiser G.C., Willman V.L. Valve replacement in the octogenarian. Ann Thorac Surg. 348:1989;104-108.
Azariades M., Fessler C.L., Ahmad A., Starr A. Aortic valve replacement in patients over 80 years of age: a comparative standard for balloon valvuloplasty. Eur J Cardio-thorac Surg. 5:1991;373-377.
Aranki S.F., Rizzo R.J., Couper G.S., Adams D.H., Collins J.J. Jr, Gildea J.S., Kinchla N.M., Cohn L.H. Aortic valve replacement in the elderly. Effect of gender and coronary artery disease on operative mortality. Circulation. 88:(5Pt2):1993;II17-II23.
Kouchoukos N.T., Lell W.A., Rogers W.J. Combined aortic valve replacement and myocardial revascularization. Ann Thorac Surg. 197:1983;721-727.
Lytle B.W., Cosgrove D.M., Loop F.D., Taylor P.L., Gill C.C., Golding L.A., Goormastic M., Groves L.K. Replacements of aortic valve combined with myocardial revascularization: determinants of early and late risk for 500 patients. Circulation. 68:1983;1149-1162.