Related Experiment Video

Updated: Jul 15, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
14:14

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Published on: December 11, 2017

Aortic valve replacement in octogenarians: risk factors for early and late mortality

Spencer J Melby1, Andreas Zierer, Scott P Kaiser

  • 1Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.

The Annals of Thoracic Surgery
|April 28, 2007
PubMed

Insights

Aortic valve replacement (AVR) in patients 80 and older shows acceptable survival. Concomitant coronary artery bypass grafting (CABG) improves outcomes, suggesting aggressive surgical treatment is warranted for this elderly population.

Area of Science:

  • Cardiovascular Surgery
  • Geriatric Medicine
  • Thoracic Surgery

Background:

  • Elderly patients (80+ years) undergoing aortic valve replacement (AVR) can achieve excellent outcomes.
  • Some clinicians hesitate to refer elderly patients for AVR.
  • This study investigates mortality risk factors in octogenarians undergoing AVR, with or without concomitant coronary artery bypass grafting (CABG).

Purpose of the Study:

  • To analyze risk factors for operative and long-term mortality in patients aged 80 years and older undergoing AVR.
  • To evaluate the impact of concomitant CABG on survival in this patient group.
  • To determine if aggressive surgical intervention is appropriate for elderly patients requiring AVR.

Main Methods:

  • Retrospective review of 245 patients (mean age 83.6 years) who underwent AVR between 1993 and 2005.
  • Analysis included patients who had AVR with (n=140) or without CABG (n=105).
  • Multivariate logistic regression, Kaplan-Meier survival estimates, and Cox proportional hazards analysis were used to identify mortality predictors.

Main Results:

  • Operative mortality was 9%. Independent risk factors for operative mortality included postoperative renal failure, stroke, and intraaortic balloon pump (IABP) placement.
  • Five-year survival was 56%. Factors decreasing long-term survival included regurgitant valve pathology, IABP, renal failure, and stroke.
  • Concomitant CABG was protective against operative mortality and improved long-term survival. Preoperative NYHA classification did not impact survival.

Conclusions:

  • Patients aged 80 and older have acceptable short-term and long-term survival after AVR, irrespective of NYHA class.
  • Concomitant CABG significantly improved both operative and long-term survival in this elderly population.
  • Aggressive surgical treatment, including AVR with or without CABG, is recommended for most octogenarian patients.
Abstract

More Related Videos

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement08:50

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Published on: March 26, 2018

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots12:17

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

Published on: May 21, 2017

Related Concept Videos

Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
Aortic Regurgitation IV: Nursing Management01:17

Aortic Regurgitation IV: Nursing Management

A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
Mitral Valve Prolapse II: Assessment and Management01:22

Mitral Valve Prolapse II: Assessment and Management

IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular tachycardia.
Mitral Valve Prolapse I: Introduction01:27

Mitral Valve Prolapse I: Introduction

IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...