Octogenarians with aortic stenosis. Outcome after aortic valve replacement.
To assess the outcome of aortic valve replacement for aortic stenosis in octogenarians, we retrospectively studied 64 patients, aged 80-89 years, who underwent aortic valve replacement for aortic stenosis from 1974 to 1987. Mean aortic valve gradient was 61 +/- 22 mm Hg, and valve area was 0.5 +/- 0.2 cm2. Concurrent coronary artery bypass grafting was performed in 29 patients, mitral valve replacement in two, and both procedures in two. Serious, comorbid, noncardiac conditions were infrequent. In-hospital mortality was 9.4%. Outcomes were classified as 1a) uncomplicated; 1b) complicated (technically complicated surgery, temporary encephalopathy, discharge to a rehabilitation facility, or some combination thereof) but with ultimately good results; or 2) unfavorable (death or permanent, severe neurological deficit). There were 28 (44%) patients in group 1a, 24 (38%) in group 1b, and 12 (19%) in group 2. Of 18 patients with preoperative left ventricular ejection fraction less than 50%, two (11%) were in group 2. Of 31 patients undergoing aortic valve replacement only, two (6%) were in group 2, compared with 10 of 33 (30%) patients who had concomitant coronary artery bypass grafting, mitral valve replacement, or both (p = 0.02). Late follow-up at 28 +/- 5 months revealed four cardiac and seven noncardiac deaths, with actuarial 1- and 5-year survival rates of 83 +/- 5% and 67 +/- 10%, respectively. With few exceptions, survivors were free of cardiac symptoms. Thus, short- and long-term outcomes after aortic valve replacement for aortic stenosis in otherwise healthy octogenarians is generally favorable, even in the presence of preoperative left ventricular systolic dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)
Levinson
J R
JR
Department of Medicine, Massachusetts General Hospital, Boston 02114.
Akins
C W
CW
Buckley
M J
MJ
Newell
J B
JB
Palacios
I F
IF
Block
P C
PC
Fifer
M A
MA
D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001900:Boston; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies