PMID- 17462374
OWN - NLM
STAT- MEDLINE
DCOM- 20070516
LR  - 20220330
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 83
IP  - 5
DP  - 2007 May
TI  - Aortic valve replacement in octogenarians: risk factors for early and late 
      mortality.
PG  - 1651-6; discussion 1656-7
AB  - BACKGROUND: Excellent outcomes after aortic valve replacement (AVR) in elderly 
      patients can be achieved, yet some practitioners are reticent to refer elderly 
      patients for surgery. This study analyzed risk factors for mortality in patients 
      aged 80 years and older undergoing AVR with or without concomitant coronary 
      artery bypass grafting (CABG). METHODS: A retrospective review was performed of 
      245 patients (129 women) with a mean age of 83.6 +/- 2.9 years who had AVR with 
      (n = 140) or without CABG (n = 105) at a single institution from 1993 to 2005. 
      Data were analyzed with a multivariate logistic regression for predictors of 
      operative mortality, Kaplan-Meier estimates of survival, and a Cox multivariate 
      proportional analysis of factors influencing long-term survival. RESULTS: Mean 
      preoperative New York Heart Association (NYHA) classification was 3.1 +/- 0.9, 
      and 78% (192/245) of patients were classified as NYHA class III or IV. Operative 
      (30-day) mortality was 9% (22/245). Independent risk factors for operative 
      mortality included postoperative renal failure (odds ratio [OR], 20.9; 95% 
      confidence interval [CI], 6.5 to 67.6; p < 0.001), postoperative permanent stroke 
      (OR, 11.3; 95% CI, 1.7 to 75.1; p = 0.019), or intraoperative/postoperative 
      intraaortic balloon pump (IABP) placement (OR, 14.9; 95% CI 2.9 to 75.8; p = 
      0.002). Survival after surgery was 82% (n = 183) at 1 year and 56% (n = 88) at 5 
      years. Prognostic factors for decreased long-term survival were regurgitant valve 
      pathology (hazard ratio [HR], 6.0; 95% CI, 2.5 to 14.2; p = 0.002), 
      intraoperative/postoperative IABP (HR, 2.9; 95% CI, 1.4 to 6.0; p = 0.010), 
      postoperative renal failure (HR, 3.5, 95% CI, 2.2 to 5.7; p < 0.001), and 
      postoperative stroke (HR, 7.0, 95% CI, 3.2 to 15.9; p < 0.001). Performing 
      concomitant CABG was protective in terms of operative mortality (OR, 0.3; 95% CI, 
      0.09 to 0.83; p = 0.017) and improved long-term survival (HR, 0.7, 95% CI, 0.47 
      to 0.96; p = 0.020). Preoperative NYHA classification did not affect operative or 
      long-term survival. CONCLUSIONS: Patients aged 80 years and older who undergo AVR 
      have acceptable short-term and long-term survival regardless of NYHA status. 
      Concomitant CABG improved operative and long-term survival in this population. 
      Despite their increased age, aggressive surgical treatment is warranted for most 
      patients.
FAU - Melby, Spencer J
AU  - Melby SJ
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
FAU - Zierer, Andreas
AU  - Zierer A
FAU - Kaiser, Scott P
AU  - Kaiser SP
FAU - Guthrie, Tracey J
AU  - Guthrie TJ
FAU - Keune, Jason D
AU  - Keune JD
FAU - Schuessler, Richard B
AU  - Schuessler RB
FAU - Pasque, Michael K
AU  - Pasque MK
FAU - Lawton, Jennifer S
AU  - Lawton JS
FAU - Moazami, Nader
AU  - Moazami N
FAU - Moon, Marc R
AU  - Moon MR
FAU - Damiano, Ralph J Jr
AU  - Damiano RJ Jr
LA  - eng
GR  - 5R01 HL32257/HL/NHLBI NIH HHS/United States
GR  - F32 HL078136-01/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Aged, 80 and over
MH  - Aortic Valve/*surgery
MH  - Coronary Artery Bypass/mortality
MH  - Female
MH  - Heart Valve Diseases/*surgery
MH  - Heart Valve Prosthesis Implantation/*mortality
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Analysis
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2007/04/28 09:00
MHDA- 2007/05/17 09:00
CRDT- 2007/04/28 09:00
PHST- 2006/05/12 00:00 [received]
PHST- 2006/09/18 00:00 [revised]
PHST- 2006/09/19 00:00 [accepted]
PHST- 2007/04/28 09:00 [pubmed]
PHST- 2007/05/17 09:00 [medline]
PHST- 2007/04/28 09:00 [entrez]
AID - S0003-4975(06)01893-5 [pii]
AID - 10.1016/j.athoracsur.2006.09.068 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2007 May;83(5):1651-6; discussion 1656-7. doi: 
      10.1016/j.athoracsur.2006.09.068.