Heart valve surgery in octogenarians: operative and long-term results

Department of Surgery (2), Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
Heart and Vessels (Impact Factor: 2.11). 09/2010; 25(6):522-8. DOI: 10.1007/s00380-010-0009-0
Source: PubMed

ABSTRACT This study was performed to evaluate surgical outcomes in octogenarian patients undergoing valve surgery. Sixty patients (mean age 82.3 ± 1.9 years) who underwent valve surgery were reviewed. Aortic valve disease was found in 65% of the patients. Preoperatively, 20% of the patients were in NYHA class IV. An urgent operation and concomitant coronary artery bypass grafting were performed in ten patients each. A bioprosthetic valve was exclusively used for valve replacement except in two patients. Mitral valve repair was done in seven patients. Operative mortality was 13.3% for the period. No risk factors for operative mortality were detected by multivariate analysis; however, urgent operation, preoperative NYHA class IV, preoperative renal dysfunction, perioperative use of an intra-aortic balloon pumping, and prolonged cardiopulmonary bypass time had significant effects on operative mortality. The actuarial survival rate at 1 and 3 years after surgery was 82.6 and 71.5%, respectively, and 97.6% of late survivors reported that their activity level was equal to or better than the preoperative level. Valve surgery can be performed in octogenarian patients with acceptable mortality, good long-term results, and good quality of life. Early referral to surgery should be important to obtain a better postoperative outcome.

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    ABSTRACT: The aim of this study was to compare the immediate outcome of patients undergoing transcatheter (TAVI) versus surgical aortic valve replacement with the sutureless Perceval bioprosthesis (SU-AVR). This is a retrospective multicenter analysis of 773 patients who underwent either TAVI (394 patients, mean age, 80.8 ± 5.5 years, mean EuroSCORE II 5.6 ± 4.9 %) or SU-AVR (379 patients, 77.4 ± 5.4 years, mean EuroSCORE II 4.0 ± 3.9 %) with or without concomitant myocardial revascularization. Data on SU-AVRs were provided by six European institutions (Belgium, Finland, Germany, Italy and Sweden) and data on TAVIs were provided by a single institution (Catania, Italy). In-hospital mortality was 2.6 % after SU-AVR and 5.3 % after TAVI (p = 0.057). TAVI was associated with a significantly high rate of mild (44.0 vs. 2.1 %) and moderate-severe paravalvular regurgitation (14.1 vs. 0.3 %, p < 0.0001) as well as the need for permanent pacemaker implantation (17.3 vs. 9.8 %, p = 0.003) compared with SU-AVR. The analysis of patients within the 25th and 75th percentiles interval of EuroSCORE II, i.e., 2.1-5.8 %, confirmed the findings of the overall series. One-to-one propensity score-matched analysis resulted in 144 pairs with similar baseline characteristics and operative risk. Among these matched pairs, in-hospital mortality (6.9 vs. 1.4 %, p = 0.035) was significantly higher after TAVI. SU-AVR with the Perceval prosthesis in intermediate-risk patients is associated with excellent immediate survival and is a valid alternative to TAVI in these patients.
    Heart and Vessels 01/2015; DOI:10.1007/s00380-014-0623-3 · 2.11 Impact Factor
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    ABSTRACT: IMPORTANCE There is a need to describe contemporary outcomes of surgical aortic valve replacement (AVR) as the population ages and transcatheter options emerge. OBJECTIVE To assess procedure rates and outcomes of surgical AVR over time. DESIGN, SETTING, AND PARTICIPANTS A serial cross-sectional cohort study of 82 755 924 Medicare fee-for-service beneficiaries undergoing AVR in the United States between 1999 and 2011. MAIN OUTCOMES AND MEASURES Procedure rates for surgical AVR alone and with coronary artery bypass graft (CABG) surgery, 30-day and 1-year mortality, and 30-day readmission rates. RESULTS The AVR procedure rate increased by 19 (95% CI, 19-20) procedures per 100 000 person-years over the 12-year period (P<.001), with an age-, sex-, and race-adjusted rate increase of 1.6% (95% CI, 1.0%-1.8%) per year. Mortality decreased at 30 days (absolute decrease, 3.4%; 95% CI, 3.0%-3.8%; adjusted annual decrease, 4.1%; 95% CI, 3.7%- 4.4%) per year and at 1 year (absolute decrease, 2.6%; 95% CI, 2.1%-3.2%; adjusted annual decrease, 2.5%; 95% CI, 2.3%-2.8%). Thirty-day all-cause readmission also decreased by 1.1% (95% CI, 0.9%-1.3%) per year. Aortic valve replacement with CABG surgery decreased, women and black patients had lower procedure and higher mortality rates, and mechanical prosethetic implants decreased, but 23.9% of patients 85 years and older continued to receive a mechanical prosthesis in 2011. CONCLUSIONS AND RELEVANCE Between 1999 and 2011, the rate of surgical AVR for elderly patients in the United States increased and outcomes improved substantially. Medicare data preclude the identification of the causes of the findings and the trends in procedure rates and outcomes cannot be causally linked. Nevertheless, the findings may be a useful benchmark for outcomes with surgical AVR for older patients eligible for surgery considering newer transcatheter treatments.
    JAMA The Journal of the American Medical Association 11/2013; 310(19):2078-85. DOI:10.1001/jama.2013.282437 · 30.39 Impact Factor
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    ABSTRACT: BACKGROUND: The constantly increasing life-expectancy has led to a high incidence of severe heart diseases in elderly people. The aim of this study was to compare the 30-day morbidity and mortality of octogenarians (group I) with a cohort younger than 60 years (group II). METHODS: Both groups (July 2008 and July 2011) were extracted from the Cardiac database. Demographic data, risk factors, surgical procedures and complications were double-checked. To compare the proportions of patients, Fisher's exact test was performed. RESULTS: In group I (n = 348 patients, 82.6±2.6 years) elective cases (35.3% valvular procedures) were performed in 77.6% and in 67.9% in group II (n = 656 patients, 50±2.4 years). The ICU-stay was 86±108 h (10–1040 h) (median: 51 h) in group I versus 94±256 h (3–4700 h) (median: 46 h). Postoperative renal failure occured in 2.9% in group I. After 17.9 h (1–760 h) (median 4.5 h) patients in group I could be weaned from ventiulation (group II: 26.4 h [1–1230 h] [median 4 h]). The need for blood transfusion was 1.7 units (0–10) in group I (1 unit (0–28) in group II). The 30-day mortality was 5.5% (n = 19) in group I versus 4.7 (n = 31) in group II and was in both groups lower than the expected EuroScore mortality of 16.1 and 6.25%. CONCLUSIONS: It must be argued that the surgical outcome of elderly patients is much better than the individual feeling in the daily routine. We proved that octogenarians should not be excluded from possible benefits of cardiac surgery. As a result of comparing postoperative data of the two different groups we cannot attribute higher costs for our elderly patients.
    European Surgery 12/2011; 43(6). DOI:10.1007/s10353-011-0054-7 · 0.26 Impact Factor

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