title: Valve Replacement for Moderate Aortic Stenosis in Octogenarians Undergoing Revascularization.
abstract: OBJECTIVE
  The study aim was to determine if the 'prophylactic' replacement of the aortic valve to treat moderate aortic valve stenosis (AS) in octogenarians undergoing cardiac surgery for coronary disease can influence outcome, and is also justified.
  
  
  METHODS
  In a retrospective analysis of octogenarians operated on at the authors' center between 1998 and 2012, the patients were allocated to: Group I, isolated coronary artery bypass graft surgery (CABG; n = 159); Group II, combined CABG and aortic valve replacement (AVR) with the primary indication for surgery being severe AS (n = 156); and Group III, combined AVR +CABG with coronary disease being the primary indication and concomitant 'prophylactic' AVR (n = 34).
  
  
  RESULTS
  The hospital mortality for octogenarians undergoing CABG+AVR was 8% compared to 2% for isolated CABG (p = 0.02). Survival at one year was higher in the isolated CABG group (94%) than in the CABG+AVR group (86%) (p = 0.01), but was no different at five years. Mortality according to AVR indication was similar (Group II 8% versus Group III 9%), as was one- and five-year survival. Group III had a higher preoperative co-morbid risk profile, including logistic EuroSCORE 21.7% versus 18% in Group II (p = 0.05), more recent myocardial infarctions, previous percutaneous interventions, peripheral vascular disease, and poor left ventricular function. Long-term symptomatic relief was excellent in Group III. Patients whose predominant disease profile was ischemic (Groups I and III) had a higher long-term risk of recurrent angina and stroke.
  
  
  CONCLUSIONS
  In-hospital mortality is higher for octogenarians undergoing CABG+AVR compared to those undergoing isolated CABG. In the present study, a 'prophylactic' AVR was justified in patients with moderate AS, and their increased mortality (versus isolated CABG) was congruent with a higher preoperative co-morbid risk profile. Excellent long- term symptom-free survival further justifies 'prophylactic' AVR in octogenarians undergoing CABG with coexistent moderate AS.
authors.forename: Ana
authors.initials: A
authors.lastname: Lopez-Marco
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tymko
authors.forename: Ulrich
authors.initials: U
authors.lastname: Von Oppell
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014852:Wales