title: Aortic Valve Replacement With or Without Concurrent Coronary Artery Bypass Grafting in Octogenarians: Eight-Year Cohort Study.
abstract: BACKGROUND
  With the introduction of transcatheter aortic valve implantation (TAVI), there is increasing interest in evaluating outcomes of aortic valve replacement (AVR) with or without (+/-) concurrent coronary artery bypass grafting (CABG) particularly in high-risk patients. We reviewed the characteristics and outcomes of octogenarians undergoing isolated AVR and AVR+CABG.
  
  
  METHODS
  All patients 80 years of age or older undergoing AVR+/-CABG at Auckland City Hospital during 2005-2012 were included, and their characteristics and outcomes analysed.
  
  
  RESULTS
  There were 93 and 104 octogenarians respectively undergoing isolated AVR and AVR+CABG with mean follow-up of 4.4+/-2.2 years and 4.1+/-2.3 years. Significant differences in baseline and operative characteristics contributed to higher EuroSCORE II (5.9 vs 6.4%, P=0.016) and STS Score (4.9 vs 6.9%, P<0.001) for AVR+CABG patients. They also had a significantly higher rate of 30-day mortality (0.0% vs 6.7%, P=0.015) and prolonged ventilation>24hours (10.7% vs 23.1%, P<0.001), but not composite morbidity (P=0.248) or stroke (P=0.709). Long-term survival was similar at one, three and five years; 94.6%, 82.6% and 73.0% for AVR and 91.3%, 86.1% and 67.6% for AVR+CABG. Independent predictors of 30-day mortality included reduced creatinine clearance and history of myocardial infarction.
  
  
  CONCLUSIONS
  AVR+CABG had significantly higher but acceptable 30-day mortality in octogenarians than AVR. We have identified prognostic factors important in the decision-making of treatment modality, where age alone should not preclude surgery.
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand. Electronic address: TWang@adhb.govt.nz.
authors.forename: Tom Kai Ming
authors.initials: TK
authors.lastname: Wang
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: David Hm
authors.initials: DH
authors.lastname: Choi
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Tharumenthiran
authors.initials: T
authors.lastname: Ramanathan
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Ruygrok
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement
keywords: Aortic valve replacement; Cardiac surgery; Coronary artery bypass grafting; Geriatrics