Abstract
Purpose: The aim of this study was to investigate our clinical experience in a contemporary series of aortic valve replacement (AVR) for aortic stenosis (AS) with or without coronary artery bypass grafting (CABG), and compare the early and mid-term results between patients aged more than 80 years and those aged less than 80 years. Methods: A retrospective review was performed of 258 consecutive patients with aortic stenosis (AS) who underwent AVR between August 2002 and December 2010 at Juntendo University Hospital. Results: Operative mortality was 7.3% in patients aged 80 years and older, compared with 3.6% in younger patients. Thus, operative mortality was higher in the older patients compared with the younger patients, but was not statistically significant between the two groups. Age more than 80 years was not a predictor of operative mortality. Advanced NYHA class (p = 0.03; odds ratio [OR], 9.5) was found to be a multivariate independent predictor of operative mortality. Patients aged 80 years and older were significantly more likely to suffer from respiratory failure after surgery than younger patients, but there were no significant differences in any other complications between the two age groups. Non-home discharge rate was significantly higher in the patients aged 80 years and older (21.9%) than in the younger patients (5.5%). Three-year survival was 84% in patients aged more than 80 years, and 83% of these elderly patients were living at home at the last follow-up. Conclusions: Patients aged 80 years and older have acceptable results of AVR with slightly increased risk of early mortality and morbidity compared with younger patients.
Highlights
Life expectancy is steadily increasing in developed coun-tries, and more than 8.4 million people aged 80 years and older live in Japan
The aim of this study was to investigate our clinical experience in a contemporary series of aortic valve replacement (AVR) for aortic stenosis (AS) with or without coronary artery bypass grafting (CABG), and compare the early and mid-term results between patients aged more than 80 years and those aged less than 80 years
ejection fraction (EF) ≤ 40%, New York Heart Association (NYHA) class III-IV, creatinine ≥ 2 mg/dL, diabetes mellitus, and old myocardial infarction emerged as risk factors of operative mortality
Summary
Tries, and more than 8.4 million people aged 80 years and older live in Japan. In this population, the most common structural cardiac disease is degenerative calcified aortic stenosis [1]. Current guidelines [2,3] demonstrated AVR as class I recommendation in symptomatic patients with AS, there remains significant reluctance to recommend AVR in patients greater than 80 years old [4] due mainly to the increased risk of operative mortality and morbidity in this age group. 30-day and 1-year cumulative mortality rates after TAVI have been reported to be 3.4% to 10% and 22.1% to 24.2%, respectively [5,6], and controversy exists about whether high-risk elderly patients benefit from TAVI in terms of early and midterm outcomes compared with conventional AVR. The aim of this study was to report our clinical experience in a contemporary series of AVR for AS with or without CABG, compare the early and mid-term results between patients aged more than 80 years and those aged less than 80 years, and determine the risk factors for early morbidity and mortality, non-home discharge, and mid-term mortality
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