Abstract
Background: Aortic valvular disease is the most common valvular lesion among elderly patients. Because of changing demographics, it has become increasingly frequent. Aortic valve replacement (AVR) is the only effective treatment for aortic valvular disease.
Hypothesis: This study was undertaken to evaluate the results of AV R in an elderly population.
Methods: Data were retrospectively analyzed in 117 consecutive patients (mean age 73.8 years) who underwent AV R between 1991 and 2002.
Results: Pure or predominant severe aortic stenosis was present in 108 patients. Nine patients had severe aortic regurgitation. Before valve replacement, 62.4% of the patients were in New York Heart Association (NYHA) functional class III‐IV. A bioprosthesis was implanted in 62.4% of the patients, and 37.6% received a mechanical valve. Concomitant cardiac surgical procedures were performed in 25 patients (coronary artery bypass graft in 22, mitral valve replacement in 3). There were 17 deaths, giving a perioperative mortality rate of 14.5%. Multivariate logistic regression showed that repeat surgery for bleeding, prolonged cardiopulmonary bypass time, postoperative respiratory failure, and postoperative acute renal insufficiency were significant independent predictors of operative mortality. Of the 100 hospital survivors, 78 were followed for a mean of 42.9 months. There were six deaths during follow‐up; only two of these were cardiac related. Five‐year actuarial survival for all patients and for hospital survivors were 70 and 91.1%, respectively. One year post surgery, all patients were in NYHA functional class I‐II.
Conclusion: In a selected patient population, AV R in the elderly is associated with acceptable mortality and morbidity. The outlook for hospital operative survivors is excellent with improved quality of life and an expected survival normal for this particular age.
Keywords: elderly, aortic stenosis, aortic valve replacement
Full Text
The Full Text of this article is available as a PDF (40.9 KB).
References
- 1. Ross J Jr, Braunwald E: Aortic stenosis. Circulation 1968; 38 127: (suppl): V61–V67 [DOI] [PubMed] [Google Scholar]
- 2. Faggiano P, Aurigemma GP, Rusconi C, Gaasch WH: Progression of valvular aortic stenosis in adults: Literature review and clinical implications. Am Heart J 1996; 132: 408–417 [DOI] [PubMed] [Google Scholar]
- 3. Dancy M, Dawkins K, Ward D: Ballon dilatation of the aortic valve: Limited success and early restenosis. Br Heart J 1989; 60: 236–239 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Galloway AC, Colvin SB, Grossi EA, Baumann FG, Sabban YP, Esposito R, Ribakove GH, Culliford AT, Slater JN, Glassman E, Harty S, Spencer FC: Ten‐year experience with aortic valve replacement in 482 patients 70 years of age or older: Operative risk and long‐term results. Ann Thorac Surg 1990; 49: 84–93 [DOI] [PubMed] [Google Scholar]
- 5. Craver JM, Weintraub WS, Jones EL, Guyton RA, Hatcher CR: Predictors of mortality, complications, and length of stay in aortic valve replacement for aortic stenosis. Circulation 1988; 78 188: (suppl I): I‐85–I‐90 [PubMed] [Google Scholar]
- 6. Azariades M, Fessler CL, Ahmad A, Starr A: Aortic valve replacement in patients over 80 years of age: A comparative standard for balloon valvuloplasty. Eur J Cardiothorac Surg 1991; 5: 373–377 [DOI] [PubMed] [Google Scholar]
- 7. Cullifortd AT, Galloway AC, Colvin SB, Grossi EA, Baumann FG, Esposito R, Ribakove GH, Spencer FC: Aortic valve replacement for aortic stenosis in persons aged 80 years and over. Am J Cardiol 1991; 67: 1256–1260 [DOI] [PubMed] [Google Scholar]
- 8. Elayda MAA, Hall RJ, Reul RM, Alonzo DM, Gillette N, Reul GJ, Cooley DA: Aortic valve replacement in patients 80 years and older. Operative risks and long‐term results. Circulation 1993; 88 235: (part 2): 11–16 [PubMed] [Google Scholar]
- 9. Logeais Y, Langanay T, Roussin R, Leguerrier A, Rioux C, Chaperon J, de Place C, Mabo P, Pony JC, Daubert JC, Laurent M, Almange C: Surgery for aortic stenosis in elderly patients. A study of surgical risk and predictive factors. Circulation 1994; 90: 2891–2898 [DOI] [PubMed] [Google Scholar]
- 10. Gehlot A, Mullany CJ, Ilstrup D, Schaff HV, Orszulak TA, Morris JJ, Daly RC: Aortic valve replacement in patients aged eighty years and older: Early and long‐term results. J Thorac Cardiovasc Surg 1996; 111: 1026–1036 [DOI] [PubMed] [Google Scholar]
- 11. Kolh P, Lahaye L, Gerard P, Limet R: Aortic valve replacement in the octogenarians. Perioperative outcome and clinical follow‐up. Eur J Cardiothorac Surg 1999; 16: 68–73 [DOI] [PubMed] [Google Scholar]
- 12. Aranki SF, Rizzo RJ, Couper GS, Adams DH, Collins JJ, Gildea JS, Kinchla NM, Cohn LH: Aortic valve replacement in the elderly. Effect of gender and coronary artery disease on operative mortality. Circulation 1993; 88 303: (part 2): 17–23 [PubMed] [Google Scholar]
- 13. Davis EA, Grene PS, Cameron DE, Gott VL, Laschinger JC, Stuart RS, Sussman MS, Watkins L, Baumgartner WA: Bioprosthetic versus mechanical prostheses for aortic valve replacement in the elderly. Circulation 1996; 94: 322: (suppl II): II‐121–II‐125 [PubMed] [Google Scholar]
- 14. Akins CW, Daggett WM, Vlahakes GJ, Hilgenberg AD, Torchiana DF, Madsen JC, Buckley MJ: Cardiac operations in patients 80 years old and older. Ann Thorac Surg 1997; 64: 606–615 [DOI] [PubMed] [Google Scholar]
- 15. Tseng EE, Lee CA, Cameron DE, Stuart RS, Greene PS, Sussman MS, Watkins L, Gardner TJ, Baumgartner WA: Aortic valve replacement in the elderly. Risk factors and long‐term results. Ann Surg 1997; 225: 793–804 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Asimakopoulos G, Edwards MB, Taylor KM: Aortic valve replacement in patients 80 years of age and older. Survival and cause of death based on 1100 cases: Collective results from the UK heart valve registry. Circulation 1997; 96: 3403–3408 [DOI] [PubMed] [Google Scholar]
- 17. Shapira OM, Kelleher RM, Zelingher J, Whalen D, Fitzgerald C, Aldea GS, Shemin RJ: Prognosis and quality of life after valve surgery in patients older than 75 years. Chest 1997; 112: 885–894 [DOI] [PubMed] [Google Scholar]
- 18. Milano A, Guglielmi C, De Carlo M, Di Gregorio O, Borzoni G, Verunelli F, Bortolotti U: Valve‐related complications in elderly patients with biological and mechanical aortic valves. Ann Thorac Surg 1998; 66 401: (suppl): S82–S87 [DOI] [PubMed] [Google Scholar]
- 19. Olsson M, Granstrom L, Lindblom D, Rosenqvist M, Ryden L: Aortic valve replacement in octogenarians with aortic stenosis: A case‐control study. J Am Coll Cardiol 1992; 20: 1512–1516 [DOI] [PubMed] [Google Scholar]
- 20. Tsai TP, Matloff JM, Chaux A, Kass RM, Lee ME, Czer LSC, DeRobertis MA Gray RJ: Combined valve and coronary artery bypass procedures in septuagenarians and octogenarians: Results in 120 patients. Ann Thorac Surg 1986; 42: 681–684 [DOI] [PubMed] [Google Scholar]
- 21. Jamieson WRE, Burr LH, Munro AI, Miyagishima RT, Gerein AN: Cardiac valve replacement in the elderly: Clinical performance of biological prostheses. Ann Thorac Surg 1989; 48: 173–185 [DOI] [PubMed] [Google Scholar]
- 22. Burr LH, Jamieson WRE, Munro AI, Miyagishima RT, Germann E: Porcine bioprostheses in the elderly: Clinical performance by age groups and valve positions. Ann Thorac Surg 1995; 60: S264–S269 [DOI] [PubMed] [Google Scholar]