Primary isolated aortic valve surgery in octogenarians.

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Serval ID
serval:BIB_015EDEA0C907
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Primary isolated aortic valve surgery in octogenarians.
Journal
European journal of cardio-thoracic surgery
Author(s)
Ferrari E., Tozzi P., Hurni M., Ruchat P., Stumpe F., von Segesser L.K.
ISSN
1873-734X (Electronic)
ISSN-L
1010-7940
Publication state
Published
Issued date
08/2010
Peer-reviewed
Oui
Volume
38
Number
2
Pages
128-133
Language
english
Notes
Publication types: Evaluation Studies ; Journal Article
Publication Status: ppublish
Abstract
We reviewed our surgery registry, to identify predictive risk factors for operative results, and to analyse the long-term survival outcome in octogenarians operated for primary isolated aortic valve replacement (AVR).
A total of 124 consecutive octogenarians underwent open AVR from January 1990 to December 2005. Combined procedures and redo surgery were excluded. Selected variables were studied as risk factors for hospital mortality and early neurological events. A follow-up (FU; mean FU time: 77 months) was obtained (90% complete), and Kaplan-Meier plots were used to determine survival rates.
The mean age was 82+/-2.2 (range: 80-90 years; 63% females). Of the group, four patients (3%) required urgent procedures, 10 (8%) had a previous myocardial infarction, six (5%) had a previous coronary angioplasty and stenting, 13 patients (10%) suffered from angina and 59 (48%) were in the New York Heart Association (NYHA) class III-IV. We identified 114 (92%) degenerative stenosis, six (5%) post-rheumatic stenosis and four (3%) active endocarditis. The predicted mortality calculated by logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 12.6+/-5.7%, and the observed hospital mortality was 5.6%. Causes of death included severe cardiac failure (four patients), multi-organ failure (two) and sepsis (one). Complications were transitory neurological events in three patients (2%), short-term haemodialysis in three (2%), atrial fibrillation in 60 (48%) and six patients were re-operated for bleeding. Atrio-ventricular block, myocardial infarction or permanent stroke was not detected. The age at surgery and the postoperative renal failure were predictors for hospital mortality (p value <0.05), whereas we did not find predictors for neurological events. The mean FU time was 77 months (6.5 years) and the mean age of surviving patients was 87+/-4 years (81-95 years). The actuarial survival estimates at 5 and 10 years were 88% and 50%, respectively.
Our experience shows good short-term results after primary isolated standard AVR in patients more than 80 years of age. The FU suggests that aortic valve surgery in octogenarians guarantees satisfactory long-term survival rates and a good quality of life, free from cardiac re-operations. In the era of catheter-based aortic valve implantation, open-heart surgery for AVR remains the standard of care for healthy octogenarians.

Keywords
Aged, 80 and over, Aortic Valve/surgery, Aortic Valve Insufficiency/surgery, Aortic Valve Stenosis/surgery, Bioprosthesis, Epidemiologic Methods, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation/adverse effects, Heart Valve Prosthesis Implantation/methods, Humans, Male, Prosthesis Design, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
08/09/2010 16:33
Last modification date
25/09/2019 7:08
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