PMID- 18355513
OWN - NLM
STAT- MEDLINE
DCOM- 20080416
LR  - 20220317
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 85
IP  - 4
DP  - 2008 Apr
TI  - Aortic valve replacement in octogenarians: is biologic valve the unique solution?
PG  - 1296-301
LID - 10.1016/j.athoracsur.2007.12.018 [doi]
AB  - BACKGROUND: This study analyzed morbidity, mortality, and quality of life after 
      aortic valve replacement with mechanical and biologic prostheses in octogenarian 
      patients. METHODS: A retrospective analysis was performed in 345 consecutive 
      patients, mean age of 82 +/- 2 years (range, 80 to 92), who had aortic valve 
      replacement from May 1991 to April 2005. A bioprosthesis (group I) was used in 
      200 patients (58%), and 145 (42%) received a mechanical prosthesis (group II). 
      Associated cardiac procedures were done in 211 patients (61%), of which 71% were 
      coronary artery bypass grafting. Patients had symptomatic aortic stenosis (84.3%) 
      or associated aortic insufficiency; 88% were in New York Heart Association (NYHA) 
      class III or IV. The mean preoperative aortic valve gradient was 62 +/- 16 mm Hg 
      (range, 25 to 122 mm Hg). The mean left ventricular ejection fraction was good 
      (0.52 +/- 0.12); 30 patients (8.7%) had an ejection fraction of less than 0.30. 
      RESULTS: The in-hospital mortality rate was 7.5% (26 patients); 17 (8.5%) in 
      group I and 9 (6.2%) in group II (p = 0.536) Significant predictors of operative 
      mortality were preoperative renal insufficiency (blood creatinine > 2.00 mg/mL) 
      and need for urgent operation. Mean follow-up, complete at 100%, was 40 +/- 33 
      months (range, 1 to 176 months). Long-term follow-up, using Kaplan-Meier 
      analysis, showed an overall survival of 61% at 5 years and 21% at 10 years; 
      survival by type of prosthesis was significantly higher with mechanical 
      prostheses (log-rank p = 0.03). Freedom from cerebrovascular events 
      (thromboembolic/hemorrhagic) at 5 and 10 years was 89% and 62% in the mechanical 
      group and 92% and 77% in the biologic group (p = 0.76). Postoperative NYHA 
      functional class was I or II in 96% of patients. Quality-of-life scores were 
      excellent considering the age of the patients. No differences were found between 
      the two groups. CONCLUSIONS: Surgical treatment for symptomatic aortic stenosis 
      in octogenarians has an acceptable operative risk with excellent long-term 
      results and good quality of life. In this cohort, survival rate is slightly but 
      significantly higher with mechanical prostheses.
FAU - de Vincentiis, Carlo
AU  - de Vincentiis C
AD  - Cardiac Surgery Department, San Donato Hospital, Milan, Italy.
FAU - Kunkl, Alessia B
AU  - Kunkl AB
FAU - Trimarchi, Santi
AU  - Trimarchi S
FAU - Gagliardotto, Piervincenzo
AU  - Gagliardotto P
FAU - Frigiola, Alessandro
AU  - Frigiola A
FAU - Menicanti, Lorenzo
AU  - Menicanti L
FAU - Di Donato, Marisa
AU  - Di Donato M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
CIN - Ann Thorac Surg. 2008 Apr;85(4):1301-2. PMID: 18355514
CIN - Ann Thorac Surg. 2009 Jan;87(1):350-1; author reply 351. PMID: 19101340
MH  - Age Factors
MH  - Aged, 80 and over
MH  - Aortic Valve Insufficiency/diagnostic imaging/mortality/*surgery
MH  - *Bioprosthesis
MH  - *Cause of Death
MH  - Cohort Studies
MH  - Echocardiography, Doppler
MH  - Female
MH  - Follow-Up Studies
MH  - Geriatric Assessment
MH  - Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/adverse effects/methods/*mortality
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Logistic Models
MH  - Male
MH  - Multivariate Analysis
MH  - Postoperative Complications/mortality
MH  - Probability
MH  - Prosthesis Design
MH  - Prosthesis Failure
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Sensitivity and Specificity
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - Time Factors
EDAT- 2008/03/22 09:00
MHDA- 2008/04/17 09:00
CRDT- 2008/03/22 09:00
PHST- 2007/09/09 00:00 [received]
PHST- 2007/12/05 00:00 [revised]
PHST- 2007/12/06 00:00 [accepted]
PHST- 2008/03/22 09:00 [pubmed]
PHST- 2008/04/17 09:00 [medline]
PHST- 2008/03/22 09:00 [entrez]
AID - S0003-4975(07)02498-8 [pii]
AID - 10.1016/j.athoracsur.2007.12.018 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2008 Apr;85(4):1296-301. doi: 10.1016/j.athoracsur.2007.12.018.