Aortic Valve Replacement With or Without Coronary Artery Bypass Graft Surgery: The Risk of Surgery in Patients ≥80 Years Old
Presented in part at the American College of Cardiology Meeting, Chicago, IL, March 2008.
published online 13 October 2009.
Objective
The purpose of this study was to evaluate the outcomes for elderly (≥80 years) patients undergoing aortic valve replacement (AVR) with or without coronary artery bypass graft surgery (AVR/CABG). The authors hypothesized that the mortalities of AVR and AVR/CABG are lower than that predicted by published risk scores.
Design
A retrospective analysis of data from a single-hospital database.
Setting
Single tertiary care, private practice.
Participants
Consecutive patients undergoing AVR or AVR/CABG.
Measurements
Two hundred sixty-one elderly (≥80 years) patients undergoing isolated AVR (145) or AVR/CABG (116) were evaluated. The majority (94.6%) underwent AVR for aortic valve stenosis. Outcomes were recorded and compared between the 2 surgical procedures with predicted mortalities based on published risk assessment scoring systems.
Results
The overall short-term mortality for the elderly group was 6.1% (AVR 5.5% and AVR/CABG 6.9%). The median long-term survival was 6.8 years. There were no significant differences in either morbidity or mortality between the AVR and AVR/CABG groups. Although predicted mortalities were similar for each surgical procedure, they overestimated observed outcome by up to 4-fold.
Conclusions
Short- and long-term mortality was low for this group of elderly patients undergoing AVR or AVR/CABG and not significantly different between the 2 surgical groups. Predicted outcomes were worse than that observed, consistent with the hypothesis, and supportive of a more aggressive surgical treatment for aortic valve disease in the elderly patient.
ABSTRACT