PMID- 8222150
OWN - NLM
STAT- MEDLINE
DCOM- 19931129
LR  - 20100324
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 88
IP  - 5 Pt 2
DP  - 1993 Nov
TI  - Aortic valve replacement in the elderly. Effect of gender and coronary artery 
      disease on operative mortality.
PG  - II17-23
AB  - BACKGROUND: Aortic valve replacement remains the treatment of choice for aortic 
      valve disease, even in the extreme elderly who may present with advanced 
      symptoms. Defining risk factors for short-term survival was the object of this 
      study. METHODS AND RESULTS: This was a retrospective analysis of 717 patients at 
      least 70 years of age who underwent aortic valve replacement alone or with 
      coronary artery bypass graft between 1980 and 1992. Age range was 70 to 95 years, 
      and mean age was 77 years; there were 529 septuagenarians (74%); 188 were 
      octogenarians (26%); 326 were women (45%); and 386 patients (54%) had aortic 
      valve replacement and coronary artery bypass graft. Atrial fibrillation/flutter 
      or heart block was present in 16%, and 34% of patients were in New York Heart 
      Association (NYHA) functional class IV. Aortic stenosis was present in 88%, and 
      mechanical prostheses were used in 22% of patients. There were 47 deaths, giving 
      an overall operative mortality of 6.6%, with 4.2% for aortic valve replacement 
      and 8.8% for aortic valve replacement and coronary artery bypass graft (P = .01). 
      The operative mortality for aortic valve replacement was 2.9% versus 10.3% for 
      aortic valve replacement and coronary artery bypass graft in women (P = .006). 
      The corresponding values for men were 5.6% and 7.4% (P = .31). Multivariate 
      logistic regression showed coronary artery bypass graft and NYHA class IV to be 
      significant predictors of operative mortality in women. The significant 
      predictors in men were NYHA class IV, atrial fibrillation/flutter or heart block 
      rhythm, and the use of mechanical prosthesis. Age was not a predictor of 
      operative mortality in either sex. CONCLUSIONS: Aortic valve replacement carries 
      an acceptable mortality rate in elderly patients. Female gender was a significant 
      predictor of operative mortality in the concomitant coronary artery bypass graft 
      group; however, gender was not a predictor of operative mortality in the isolated 
      aortic valve replacement group. Advance stage of the disease process represented 
      by NYHA class IV was a significant predictor of mortality for the whole group, 
      stressing the need for earlier referral for surgery.
FAU - Aranki, S F
AU  - Aranki SF
AD  - Department of Surgery, Harvard Medical School, Boston, Mass.
FAU - Rizzo, R J
AU  - Rizzo RJ
FAU - Couper, G S
AU  - Couper GS
FAU - Adams, D H
AU  - Adams DH
FAU - Collins, J J Jr
AU  - Collins JJ Jr
FAU - Gildea, J S
AU  - Gildea JS
FAU - Kinchla, N M
AU  - Kinchla NM
FAU - Cohn, L H
AU  - Cohn LH
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve
MH  - Aortic Valve Stenosis/mortality/*surgery
MH  - Bioprosthesis/*statistics & numerical data
MH  - Cause of Death
MH  - Coronary Artery Bypass/*mortality
MH  - Coronary Disease/*epidemiology/surgery
MH  - Female
MH  - Heart Valve Prosthesis/*mortality
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sex Factors
EDAT- 1993/11/01 00:00
MHDA- 2001/03/28 10:01
CRDT- 1993/11/01 00:00
PHST- 1993/11/01 00:00 [pubmed]
PHST- 2001/03/28 10:01 [medline]
PHST- 1993/11/01 00:00 [entrez]
PST - ppublish
SO  - Circulation. 1993 Nov;88(5 Pt 2):II17-23.