PMID- 17307362
OWN - NLM
STAT- MEDLINE
DCOM- 20070628
LR  - 20220330
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 31
IP  - 4
DP  - 2007 Apr
TI  - Aortic valve surgery in octogenarians: predictive factors for operative and 
      long-term results.
PG  - 600-6
AB  - OBJECTIVE: To assess factors influencing operative and long-term outcome in 
      octogenarians undergoing aortic valve surgery (AVR). METHODS: Records of 220 
      consecutive octogenarians having AVR between 1992 and 2004 were reviewed, and 
      follow-up obtained (99% complete). Of the group (mean age: 82.8 years; 174 
      females), 142 patients (65%) were in New York Heart Association (NYHA) class 
      III-IV, 22 (10%) had previous myocardial infarction, 11 (5%) had previous 
      coronary artery bypass grafting (CABG), and 8 (4%) had percutaneous aortic 
      valvuloplasty. There were 44 urgent procedures (20%), and additional CABG was 
      performed in 58 patients (26%). RESULTS: Operative mortality was 13% (9% for AVR, 
      24% for AVR+CABG). Among the 29 patients who died, 14 (48%) were operated on 
      urgently (32% mortality for urgent procedures). Causes of hospital death were 
      respiratory insufficiency or infection in 16 patients (16/29=55%), myocardial 
      infarction in 8 (28%), stroke in 2 (7%), sepsis in 2 (7%), and renal failure in 1 
      (3%). Significant postoperative complications were atrial fibrillation in 48 
      patients (22%), respiratory insufficiency in 46 (21%), permanent 
      atrio-ventricular bloc in 12 (5%), myocardial infarction in 10 (5%), hemodialysis 
      in 4 (2%), and stroke in 4 (2%). Mean hospital and intensive care unit (ICU) 
      stays were 17.6+/-5.2 and 6.9+/-3.4 days, respectively. Multivariate predictors 
      (p<0.05) of hospital death were urgent procedure, associated CABG, NYHA class IV, 
      and percutaneous aortic valvuloplasty. Age, associated CABG, and urgent procedure 
      were predictors of prolonged ICU stay. Mean follow-up was 58.2 months and 
      actuarial 5-year survival was 73.2+/-6.9%. Age, preoperative myocardial 
      infarction, urgent procedure, and duration of ICU stay were independent 
      predictors of late death. Among 130 patients alive at follow-up, 91% were angina 
      free and 81% in class I-II. CONCLUSIONS: AVR in octogenarians can be performed 
      with acceptable mortality, although significant morbidity. These results stress 
      the importance of early operation on elderly patients with aortic valve disease, 
      avoiding urgent procedures. Associated coronary artery disease is a harbinger of 
      poor operative outcome. Long-term survival and functional recovery are excellent.
FAU - Kolh, Philippe
AU  - Kolh P
AD  - Cardiothoracic Surgery Department, University Hospital of Liege, Liege, Belgium. 
      philippe.kolh@chu.ulg.ac.be
FAU - Kerzmann, Arnaud
AU  - Kerzmann A
FAU - Honore, Charles
AU  - Honore C
FAU - Comte, Laetitia
AU  - Comte L
FAU - Limet, Raymond
AU  - Limet R
LA  - eng
PT  - Journal Article
DEP - 20070220
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Aged, 80 and over
MH  - Aortic Valve/physiopathology/*surgery
MH  - Aortic Valve Insufficiency/mortality/physiopathology/surgery
MH  - Aortic Valve Stenosis/mortality/physiopathology/surgery
MH  - Female
MH  - *Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Male
MH  - Postoperative Complications
MH  - Quality of Life
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2007/02/20 09:00
MHDA- 2007/06/29 09:00
CRDT- 2007/02/20 09:00
PHST- 2006/09/28 00:00 [received]
PHST- 2006/12/26 00:00 [revised]
PHST- 2007/01/04 00:00 [accepted]
PHST- 2007/02/20 09:00 [pubmed]
PHST- 2007/06/29 09:00 [medline]
PHST- 2007/02/20 09:00 [entrez]
AID - S1010-7940(07)00011-5 [pii]
AID - 10.1016/j.ejcts.2007.01.003 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2007 Apr;31(4):600-6. doi: 10.1016/j.ejcts.2007.01.003. 
      Epub 2007 Feb 20.