Aortic valve replacement with or without coronary artery bypass graft surgery: the risk of surgery in patients > or =80 years old.
OBJECTIVE
The purpose of this study was to evaluate the outcomes for elderly (> or =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.


METHODS
A retrospective analysis of data from a single-hospital database.


METHODS
Single tertiary care, private practice.


METHODS
Consecutive patients undergoing AVR or AVR/CABG.


METHODS
Two hundred sixty-one elderly (> or =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.
Maslow
Andrew
A
Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Davol 129, 593 Eddy Street, Providence, RI 02903, USA. amaslow@rcn.com
Casey
Paula
P
Poppas
Athena
A
Schwartz
Carl
C
Singh
Arun
A
D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome