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Eur J Cardiothorac Surg 2007;31:600-606. doi:10.1016/j.ejcts.2007.01.003
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
a Cardiothoracic Surgery Department, University Hospital of Liège, Liège, Belgium
b Department of Biostatistics, University Hospital of Liège, Liège, Belgium
Received 28 September 2006; received in revised form 26 December 2006; accepted 4 January 2007.
* Corresponding author. Address: Cardiothoracic Surgery Department, University Hospital of Liège, B 35 Sart Tilman, 4000 Liège, Belgium. Tel.: +32 4 366 71 63; fax: +32 4 366 71 64. (Email: philippe.kolh{at}chu.ulg.ac.be).
Objective: To assess factors influencing operative and long-term outcome in octogenarians undergoing aortic valve surgery (AVR). Methods: Records of 220 consecutive octogenarians having AVR between 1992 and 2004 were reviewed, and follow-up obtained (99% complete). Of the group (mean age: 82.8 years; 174 females), 142 patients (65%) were in New York Heart Association (NYHA) class III–IV, 22 (10%) had previous myocardial infarction, 11 (5%) had previous coronary artery bypass grafting (CABG), and 8 (4%) had percutaneous aortic valvuloplasty. There were 44 urgent procedures (20%), and additional CABG was performed in 58 patients (26%). Results: Operative mortality was 13% (9% for AVR, 24% for AVR + CABG). Among the 29 patients who died, 14 (48%) were operated on urgently (32% mortality for urgent procedures). Causes of hospital death were respiratory insufficiency or infection in 16 patients (16/29 = 55%), myocardial infarction in 8 (28%), stroke in 2 (7%), sepsis in 2 (7%), and renal failure in 1 (3%). Significant postoperative complications were atrial fibrillation in 48 patients (22%), respiratory insufficiency in 46 (21%), permanent atrio-ventricular bloc in 12 (5%), myocardial infarction in 10 (5%), hemodialysis in 4 (2%), and stroke in 4 (2%). Mean hospital and intensive care unit (ICU) stays were 17.6 ± 5.2 and 6.9 ± 3.4 days, respectively. Multivariate predictors (p < 0.05) of hospital death were urgent procedure, associated CABG, NYHA class IV, and percutaneous aortic valvuloplasty. Age, associated CABG, and urgent procedure were predictors of prolonged ICU stay. Mean follow-up was 58.2 months and actuarial 5-year survival was 73.2 ± 6.9%. Age, preoperative myocardial infarction, urgent procedure, and duration of ICU stay were independent predictors of late death. Among 130 patients alive at follow-up, 91% were angina free and 81% in class I–II. Conclusions: AVR in octogenarians can be performed with acceptable mortality, although significant morbidity. These results stress the importance of early operation on elderly patients with aortic valve disease, avoiding urgent procedures. Associated coronary artery disease is a harbinger of poor operative outcome. Long-term survival and functional recovery are excellent.
Key Words: Aortic valve • Cardiac surgery • Elderly • Octogenarians • Quality of life
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