PMID- 29566140
OWN - NLM
STAT- MEDLINE
DCOM- 20190528
LR  - 20190528
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 54
IP  - 3
DP  - 2018 Sep 1
TI  - Conventional aortic valve replacement in 2005 elderly patients: a 32-year 
      experience.
PG  - 446-452
LID - 10.1093/ejcts/ezy072 [doi]
AB  - OBJECTIVES: Considering the good immediate results reported for transcatheter 
      aortic valve implantation in high-risk patients, the role of conventional aortic 
      valve replacement (AVR) is being questioned, especially in elderly patients. The 
      aim of this study was to evaluate our long-term results of conventional AVR in 
      octogenarians. METHODS: A total of 2005 patients aged >/=80 years underwent AVR for 
      aortic stenosis in our institution between 1978 and 2011. Of these, 1009 (50%) 
      patients had an associated extracardiac comorbidity and 650 (32%) patients had 
      coronary lesions. Valve replacement was the sole procedure in 1515 (76%) 
      patients, and 396 (19%) patients had concomitant coronary artery bypass grafting. 
      Data were collected at the time of surgery in our database, and regularly updated 
      by mailed questionnaires and telephone contact. RESULTS: Early mortality of 
      isolated AVR was 5.5% for the last 10 years of the series. Significant risk 
      factors were chronic obstructive pulmonary disease, chronic renal failure, 
      advanced cardiac disease [left or right ventricular failure, New York Heart 
      Association (NYHA) Class IV and atrial fibrillation] and coronary disease. 
      Long-term follow-up was 99.5% complete (9 patients lost to follow-up), totalling 
      8849 patient-years. Nine hundred and one patients died at late follow-up with a 
      median survival of 7.1 years, with 7 patients becoming centenarian. Apart from 
      older age, main late causes of death were cardiovascular (20.5%), neurological 
      deficit (10.2%) and cancer (10.2%). Actuarial survival was 83%, 62.5% and 25% at 
      2, 5 and 10 years, respectively. This survival compares favourably with that of a 
      French-matched population. Above all, 90% of late survivors reported functional 
      improvement. Univariable and multivariable analysis identified risk factors of 
      late death as male gender, associated comorbidity, renal failure, advanced 
      cardiac disease, atrial fibrillation and impaired ventricular function. Coronary 
      lesions, associated cardiac surgery and small diameter prostheses (19 or 21 mm) 
      did not impair long-term survival. CONCLUSIONS: AVR is effective for all age 
      groups to treat aortic stenosis. Elderly people should not be denied surgery only 
      because of their old age as conventional AVR provides an excellent quality of 
      life and restores life expectancy. Percutaneous valve implantation is to be 
      considered, in cases of non-operable or high-risk patients. However, to date, 
      open-heart surgery remains the treatment of choice for aortic stenosis for the 
      majority of patients.
FAU - Langanay, Thierry
AU  - Langanay T
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
FAU - Rouze, Simon
AU  - Rouze S
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
FAU - Tomasi, Jacques
AU  - Tomasi J
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
FAU - Aymami, Marie
AU  - Aymami M
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
FAU - Rehman, Syed M
AU  - Rehman SM
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
AD  - Department of Cardiac and Thoracic Surgery, Southampton General Hospital, 
      Southampton, UK.
FAU - Anselmi, Amedeo
AU  - Anselmi A
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
FAU - Corbineau, Herve
AU  - Corbineau H
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
FAU - Flecher, Erwan
AU  - Flecher E
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
FAU - Logeais, Yves
AU  - Logeais Y
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
FAU - Leguerrier, Alain
AU  - Leguerrier A
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
FAU - Verhoye, Jean-Philippe
AU  - Verhoye JP
AD  - Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, 
      Rennes, France.
LA  - eng
PT  - Journal Article
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 Stenosis/surgery
MH  - Comorbidity
MH  - Female
MH  - *Heart Valve Prosthesis/adverse effects/statistics & numerical data
MH  - *Heart Valve Prosthesis Implantation/adverse effects/mortality/statistics & 
      numerical data
MH  - Humans
MH  - Male
MH  - Postoperative Complications/epidemiology
MH  - Quality of Life
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Analysis
EDAT- 2018/03/23 06:00
MHDA- 2019/05/29 06:00
CRDT- 2018/03/23 06:00
PHST- 2017/09/13 00:00 [received]
PHST- 2018/02/02 00:00 [accepted]
PHST- 2018/03/23 06:00 [pubmed]
PHST- 2019/05/29 06:00 [medline]
PHST- 2018/03/23 06:00 [entrez]
AID - 4939525 [pii]
AID - 10.1093/ejcts/ezy072 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2018 Sep 1;54(3):446-452. doi: 10.1093/ejcts/ezy072.