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Aortic valve replacement in octogenarians
G Kleikamp1, K Minami, T Breymann
1Department of Thoracic and Cardiovascular Surgery, Heart Center of Northrhine-Westphalia, Bad Oeynhausen, Germany.
Insights
Aortic valve replacement (AVR) in patients over 80 years old demonstrated low early and late mortality. This study highlights AVR as a safe and effective treatment for aortic valve disease in the very elderly.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Aortic valve disease affects the elderly, often necessitating intervention.
- Aortic valve replacement (AVR) is a common treatment, but its safety in octogenarians requires evaluation.
Purpose of the Study:
- To assess the safety and efficacy of AVR in patients aged 80 years and older.
- To report early and late outcomes, including mortality and morbidity, in this specific patient cohort.
Main Methods:
- Retrospective analysis of 48 patients aged over 80 undergoing AVR between 1988 and 1990.
- Data collected included patient demographics, valve pathology, surgical procedures (isolated AVR vs. AVR with coronary bypass), and postoperative outcomes.
Main Results:
- Early mortality was 4.2% (2/48 patients).
- Late mortality occurred in 8 patients over a median follow-up of 22 months.
- Low incidence of non-fatal complications reported, with most survivors maintaining an independent lifestyle.
Conclusions:
- Aortic valve replacement in patients over 80 years old can be performed with acceptable mortality rates.
- The procedure is associated with a low rate of non-fatal complications, enabling a good quality of life post-surgery.
Abstract:
In a consecutive series of 1109 patients undergoing aortic valve replacement (AVR) between January 1988 and December 1990, there were 48 patients (33 female, 15 male) over 80 years of age (mean age 83.5 years, median 82.9 years). Of those, 33 had aortic stenosis and 15 combined aortic valve disease, with additional coronary artery disease being present in 36. Isolated AVR was performed in 25 patients, and it was combined with coronary venous bypass grafting, with 1-4 (mean 1.8) peripheral anastomoses in 23. Two patients died within 30 days (early mortality 4.2%). Non-fatal complications included one hemiparesis, four transient cerebral disorders, two cases of pneumonia which led to ventilatory assistance, three rethoracotomies because of postoperative bleeding, 15 tachycardias and one transient AV block. Late results were obtained after a median follow up time of 22 months. There were eight late deaths (four cardiac related, four not related) and a low incidence of non-fatal complications (two episodes of gastrointestinal bleeding while on oral anticoagulation, one cerebral transient ischemic attack and one acute left ventricular failure). Nine patients are in NYHA Class I, 12 in Class I-II, 11 in Class II, three in Class II-III and three in Class III. Of the surviving 38 patients, four are currently living in a home for the aged or a nursing home, while all the others are living in their own homes and are able to sustain a relatively independent life-style. We conclude that in very old patients with aortic valve disease, AVR can be performed with low mortality and few non-fatal complications.