title: Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients.
abstract: OBJECTIVE
  Although the number of elderly patients undergoing combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is increasing, the early and mid-term outcomes of this combined procedure remain to be determined. We sought to elucidate the early and mid-term outcomes of elderly (≥75 years) vs non-elderly (<75 years) patients who underwent combined AVR and CABG.
  
  
  METHODS
  Between September 2004 and September 2011, 259 patients underwent combined AVR and CABG at our institute, including 155 elderly patients (59.8%; Elderly group) with a mean age of 79.8 ± 3.6 years and 104 non-elderly patients (40.2%; Non-elderly group) with a mean age of 67.3±5.8 years. Early and mid-term outcomes were compared, and multivariate analyses were performed to determine the risk factors for morbidity and mortality. The mean follow-up times were 33.1±21.7 and 37.4±22.2 months in the Elderly and Non-elderly groups, respectively.
  
  
  RESULTS
  The mean number of anastomoses and the frequency of use of the internal thoracic artery were similar between the two groups. The use of a mechanical valve was less frequent in the Elderly group than in the Non-elderly group (11.6 vs 60.6%, P<0.001). The Elderly and Non-elderly groups had similar rates of operative death (1.9 vs 1.0%, P=0.651), early stroke (2.6 vs 1.0%, P=0.651), 5-year overall survival (83.1±4.8 vs 87.2±5.2%, P=0.358), 5-year freedom from cardiac death (92.3±2.7 vs 94.8±3.4%, P=0.570) and 5-year freedom from stroke (94.0±2.6 vs 99.0±1.0%, P=0.097). Cox proportional hazards analyses identified diabetes, creatinine level and EuroSCORE II, but not age, as independent predictors of overall mortality rate.
  
  
  CONCLUSIONS
  Early and mid-term outcomes of combined AVR and CABG were similar between elderly and non-elderly patients. Older age was not a risk factor for mortality in patients undergoing combined AVR plus CABG, and this procedure should be recommended in properly selected elderly patients.
authors: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors: Toshihiro
authors: T
authors: Fukui
authors: Ko
authors: K
authors: Bando
authors: Sachiko
authors: S
authors: Tanaka
authors: Tomoya
authors: T
authors: Uchimuro
authors: Minoru
authors: M
authors: Tabata
authors: Shuichiro
authors: S
authors: Takanashi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Aortic valve replacement; Coronary artery bypass grafting; Elderly