PMID- 20304666
OWN - NLM
STAT- MEDLINE
DCOM- 20110418
LR  - 20191210
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 38
IP  - 2
DP  - 2010 Aug
TI  - Primary isolated aortic valve surgery in octogenarians.
PG  - 128-33
LID - 10.1016/j.ejcts.2010.01.049 [doi]
AB  - OBJECTIVES: We reviewed our surgery registry, to identify predictive risk factors 
      for operative results, and to analyse the long-term survival outcome in 
      octogenarians operated for primary isolated aortic valve replacement (AVR). 
      METHODS: A total of 124 consecutive octogenarians underwent open AVR from January 
      1990 to December 2005. Combined procedures and redo surgery were excluded. 
      Selected variables were studied as risk factors for hospital mortality and early 
      neurological events. A follow-up (FU; mean FU time: 77 months) was obtained (90% 
      complete), and Kaplan-Meier plots were used to determine survival rates. RESULTS: 
      The mean age was 82+/-2.2 (range: 80-90 years; 63% females). Of the group, four 
      patients (3%) required urgent procedures, 10 (8%) had a previous myocardial 
      infarction, six (5%) had a previous coronary angioplasty and stenting, 13 
      patients (10%) suffered from angina and 59 (48%) were in the New York Heart 
      Association (NYHA) class III-IV. We identified 114 (92%) degenerative stenosis, 
      six (5%) post-rheumatic stenosis and four (3%) active endocarditis. The predicted 
      mortality calculated by logistic European System for Cardiac Operative Risk 
      Evaluation (EuroSCORE) was 12.6+/-5.7%, and the observed hospital mortality was 
      5.6%. Causes of death included severe cardiac failure (four patients), 
      multi-organ failure (two) and sepsis (one). Complications were transitory 
      neurological events in three patients (2%), short-term haemodialysis in three 
      (2%), atrial fibrillation in 60 (48%) and six patients were re-operated for 
      bleeding. Atrio-ventricular block, myocardial infarction or permanent stroke was 
      not detected. The age at surgery and the postoperative renal failure were 
      predictors for hospital mortality (p value <0.05), whereas we did not find 
      predictors for neurological events. The mean FU time was 77 months (6.5 years) 
      and the mean age of surviving patients was 87+/-4 years (81-95 years). The 
      actuarial survival estimates at 5 and 10 years were 88% and 50%, respectively. 
      CONCLUSIONS: Our experience shows good short-term results after primary isolated 
      standard AVR in patients more than 80 years of age. The FU suggests that aortic 
      valve surgery in octogenarians guarantees satisfactory long-term survival rates 
      and a good quality of life, free from cardiac re-operations. In the era of 
      catheter-based aortic valve implantation, open-heart surgery for AVR remains the 
      standard of care for healthy octogenarians.
CI  - Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by 
      Elsevier B.V. All rights reserved.
FAU - Ferrari, Enrico
AU  - Ferrari E
AD  - Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), 46 
      rue du Bugnon, CH-1011, Lausanne, Switzerland. enricoferrari@bluewin.ch
FAU - Tozzi, Piergiorgio
AU  - Tozzi P
FAU - Hurni, Michel
AU  - Hurni M
FAU - Ruchat, Patrick
AU  - Ruchat P
FAU - Stumpe, Frank
AU  - Stumpe F
FAU - von Segesser, Ludwig K
AU  - von Segesser LK
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20100320
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/*surgery
MH  - Aortic Valve Insufficiency/surgery
MH  - Aortic Valve Stenosis/surgery
MH  - Bioprosthesis
MH  - Epidemiologic Methods
MH  - Female
MH  - Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/adverse effects/*methods
MH  - Humans
MH  - Male
MH  - Prosthesis Design
MH  - Treatment Outcome
EDAT- 2010/03/23 06:00
MHDA- 2011/04/19 06:00
CRDT- 2010/03/23 06:00
PHST- 2009/09/08 00:00 [received]
PHST- 2010/01/24 00:00 [revised]
PHST- 2010/01/26 00:00 [accepted]
PHST- 2010/03/23 06:00 [entrez]
PHST- 2010/03/23 06:00 [pubmed]
PHST- 2011/04/19 06:00 [medline]
AID - S1010-7940(10)00113-2 [pii]
AID - 10.1016/j.ejcts.2010.01.049 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2010 Aug;38(2):128-33. doi: 10.1016/j.ejcts.2010.01.049. 
      Epub 2010 Mar 20.