Coronary artery bypass grafting combined with aortic valve replacement in healthy octogenarians does not increase postoperative risk.
OBJECTIVE
Critical aortic stenosis with or without coronary artery disease is increasingly common in octogenarians. Surgery is the treatment of choice, but indications and results of aortic valve replacement (AVR), particularly when combined with coronary artery bypass grafting (CABG) are debated. We investigated whether the combined procedure of AVR and CABG increased postoperative risk compared with isolated AVR in otherwise healthy octogenarians.


METHODS
In the period 1994-1998, AVR was performed in 94 patients above 80 years, the majority in NYHA class III and IV. Combined AVR and CABG was performed in 52/94 patients. The patients were studied retrospectively by collecting data from hospital records and followed for 0-7 years.


RESULTS
Mean age was 82 +/- 2.3 years, sex (male/female) 33/61, left ventricular ejection fraction 70 +/- 18%, transvalvular peak pressure gradient 63 +/- 20 mmHg and aortic valve area 0.5 +/- 0.2 cm(2). Early mortality (< 30 days) was 4/42 (9.5%) after AVR and 4/52 (7.6%) after AVR and CABG (p = NS between groups). Three-year survival was 33/42 (78.5%) after AVR and 42/52 (80.7%) after AVR and CABG (p = NS between groups).


CONCLUSIONS
AVR with concomitant CABG in octogenarians with aortic stenosis who are otherwise healthy, may be performed without increased risk.
Brunvand
Harald
H
Department of Cardiology, Rikshospitalet, University of Oslo, Norway. harald.brunvand@rikshospitalet.no
Offstad
Jon
J
Nitter-Hauge
Sigurd
S
Svennevig
Jan Ludvig
JL
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D004417:Dyspnea / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013575:Syncope / Q000453:epidemiology; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome