Abstract
SummaryObjectiveIn the last decade, the number of elderly patients suffering from aortic valve disease has significantly increased. This study aimed to identify possible factors that could affect surgical and long-term outcomes in the light of a literature review regarding the management of aortic valve disease in the elderly.MethodsBetween January 1990 and December 2012, a total of 114 patients (64 males, 50 females; mean age 76.6 ± 3.6 years; range 70–87 years) with aortic valve replacement (AVR) alone, or combined with coronary artery bypass grafting (CABG) or mitral surgery in our hospital, were retrospectively analysed.ResultsIn-hospital mortality was seen in 19 patients. The major causes of in-hospital mortality were low-cardiac output syndrome in eight patients (42.1%), respiratory insufficiency or infection in six (31.5%), multi-organ failure in four (21%), and stroke in one patient (5.2%). The main postoperative complications included arrhythmia in 26 patients (22.8%), renal failure in 11 (9.6%), respiratory infection in nine (7.9%), and stroke in three patients (2.6%). The mean length of intensive care unit and hospital stays were 6.4 ± 4.3 and 18 ± 12.8 days, respectively. During follow up, late mortality was seen in 28 patients (29.4%). Possible risk factors for long-term mortality were type of prosthesis, EuroSCORE ≥ 15, postoperative pacemaker implantation, respiratory infection, and haemodialysis. Among 65 long-term survivors, their activity level was good in 53 (81.5%) and poor in two.ConclusionsOur study results demonstrated that an individually tailored approach including scheduled surgery increases short- and long-term outcomes of AVR in patients aged ≥ 70 years. In addition, shorter cardiopulmonary bypass time may be more beneficial in this high-risk patient population.
Highlights
MethodsThis retrospective study included a total of 114 patients (64 males, 50 females; mean age 76.6 ± 3.6 years; range 70–87 years) with aortic valve replacement (AVR) alone, or combined with coronary artery bypass grafting (CABG) or mitral valve surgery, admitted between January 1990 and December 2012
Shorter cardiopulmonary bypass time may be more beneficial in this high-risk patient population
Despite optimal selection of the prosthesis to minimise the incidence of pacemaker implantation, we found no correlation among peri-operative risk factors, including prosthesis type (p = 0.457)
Summary
This retrospective study included a total of 114 patients (64 males, 50 females; mean age 76.6 ± 3.6 years; range 70–87 years) with AVR alone, or combined with coronary artery bypass grafting (CABG) or mitral valve surgery, admitted between January 1990 and December 2012. Informed consent, which was obtained from the patients, was confirmed by the IRB. Bileaflet prostheses were mostly used, based on our experience with mechanical valve implantation and due to the poor socioeconomic status of the country in those years. During 2012, all accessible survivors were questioned to obtain data regarding their health status, the presence of chest pain, functional grades of dyspnoea [New York Heart Association (NYHA) class], and quality of life. 98.9% of the survivors (n = 64) completed follow up through out-patient clinic visits or phone interviews
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