PMID- 28675910
OWN - NLM
STAT- MEDLINE
DCOM- 20181009
LR  - 20181009
IS  - 1439-1902 (Electronic)
IS  - 0171-6425 (Linking)
VI  - 66
IP  - 4
DP  - 2018 Jun
TI  - Stentless Bioprostheses for Aortic Valve Replacement in Octogenarians: The 
      Influence of Coronary Artery Disease.
PG  - 322-327
LID - 10.1055/s-0037-1604048 [doi]
AB  - BACKGROUND: We sought to determine the long-term results of stentless biological 
      heart valve replacement in octogenarians to find out whether coronary artery 
      disease or the coronary artery bypass grafting (CABG) procedure itself influences 
      survival in these aged patients. METHODS: From 4,012 patients undergoing aortic 
      valve replacement (AVR) with a stentless prosthesis (Freestyle, Medtronic) at a 
      single center, 721 patients were older than 80 years. They had a mean age of 
      83 +/-  2 (2,320 patient years), the male/female ratio was 42:58, NYHA (New York 
      Heart Association) class I and II was prevalent in 22.8%, preoperative atrial 
      fibrillation (AF) in 20.6%, coronary artery disease in 56.1%, mitral valve 
      disease in 12.5%, and aortic disease in 3.5%. Follow-up included a total of 
      11,546 patient years (mean follow-up time: 74 +/- 53 months); follow-up mortality 
      data were 96.3% complete. RESULTS: In these aged patients, 30-day mortality in 
      the isolated AVR group (10.3%) was similar to that in the AVR + CABG group 
      (13.4%). Although long-term survival (15 years) in the octogenarian population is 
      low (9% in the AVR group and 6% in the AVR + CABG group), it was not different 
      (p = 0.191) between patients with and without coronary artery disease. The stroke 
      rate and the myocardial infarction rate, respectively, in the AVR + CABG group 
      (0.43%/100 patient years and 0.17%/100 patient years) were only insignificantly 
      higher than that in the isolated AVR group (each 0.01%/100 patient years). The 
      actuarial freedom from reoperation was 99% in both the groups. CONCLUSION: Use of 
      the Freestyle stentless valve prosthesis for AVR is feasible also in 
      octogenarians. The existence of coronary artery disease leads to concomitant 
      bypass surgery, but not a higher level of perioperative or long-term mortality.
CI  - Georg Thieme Verlag KG Stuttgart . New York.
FAU - Ennker, Juergen
AU  - Ennker J
AD  - Herzzentrum, Helios Klinikum Siegburg, Siegburg, Germany.
AD  - Medizinische Fakultat, Universitat Witten-Herdecke, Witten, Germany.
FAU - Zadeh, Behnam
AU  - Zadeh B
AD  - Institut fur Medizin Statistik, Justus-Liebig-Universitat Giessen, Giessen, 
      Germany.
AD  - Klinik fur Herz-, Kinderherz- und Gefasschirurgie, Justus-Liebig-Universitat 
      Giessen, Giessen, Germany.
FAU - Pons-Kuehnemann, Joern
AU  - Pons-Kuehnemann J
AD  - Institut fur Medizin Statistik, Justus-Liebig-Universitat Giessen, Giessen, 
      Germany.
FAU - Niemann, Bernd
AU  - Niemann B
AD  - Klinik fur Herz-, Kinderherz- und Gefasschirurgie, Justus-Liebig-Universitat 
      Giessen, Giessen, Germany.
FAU - Grieshaber, Philippe
AU  - Grieshaber P
AD  - Klinik fur Herz-, Kinderherz- und Gefasschirurgie, Justus-Liebig-Universitat 
      Giessen, Giessen, Germany.
FAU - Ennker, Ina C
AU  - Ennker IC
AD  - Klinik fur Plastische-, Hand- und Wiederherstellungschirurgie, Med. Hochschule 
      Hannover, Hannover, Germany.
FAU - Boening, Andreas
AU  - Boening A
AD  - Klinik fur Herz-, Kinderherz- und Gefasschirurgie, Justus-Liebig-Universitat 
      Giessen, Giessen, Germany.
LA  - eng
PT  - Journal Article
DEP - 20170704
PL  - Germany
TA  - Thorac Cardiovasc Surg
JT  - The Thoracic and cardiovascular surgeon
JID - 7903387
SB  - IM
MH  - Aged, 80 and over
MH  - Aortic Valve/diagnostic imaging/physiopathology/*surgery
MH  - *Bioprosthesis
MH  - *Coronary Artery Bypass/adverse effects/mortality
MH  - Coronary Artery Disease/diagnostic imaging/mortality/physiopathology/*surgery
MH  - Female
MH  - Heart Valve Diseases/diagnostic imaging/mortality/physiopathology/*surgery
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/adverse effects/*instrumentation/mortality
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Proportional Hazards Models
MH  - Prosthesis Design
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
COIS- Disclosure The authors report no conflicts of interest in this work.
EDAT- 2017/07/05 06:00
MHDA- 2018/10/10 06:00
CRDT- 2017/07/05 06:00
PHST- 2017/07/05 06:00 [pubmed]
PHST- 2018/10/10 06:00 [medline]
PHST- 2017/07/05 06:00 [entrez]
AID - 10.1055/s-0037-1604048 [doi]
PST - ppublish
SO  - Thorac Cardiovasc Surg. 2018 Jun;66(4):322-327. doi: 10.1055/s-0037-1604048. Epub 
      2017 Jul 4.