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Published on: May 21, 2017
Valve Replacement for Moderate Aortic Stenosis in Octogenarians Undergoing Revascularization
Prophylactic aortic valve replacement (AVR) in octogenarians with moderate aortic valve stenosis undergoing coronary artery bypass grafting (CABG) is justified. While in-hospital mortality is higher, long-term symptom-free survival is excellent, supporting this approach in carefully selected patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Octogenarians undergoing cardiac surgery present complex treatment decisions.
- The role of prophylactic aortic valve replacement (AVR) in patients with moderate aortic valve stenosis (AS) undergoing coronary artery bypass grafting (CABG) is debated.
Purpose of the Study:
- To evaluate the impact and justification of prophylactic AVR in octogenarians with moderate AS undergoing CABG.
- To compare outcomes between isolated CABG, CABG with indicated AVR, and CABG with prophylactic AVR.
Main Methods:
- Retrospective analysis of octogenarians operated on between 1998 and 2012.
- Three groups: isolated CABG (n=159), CABG + indicated AVR for severe AS (n=156), and CABG + prophylactic AVR for moderate AS (n=34).
- Comparison of hospital mortality, survival rates, and long-term symptomatic relief.
Main Results:
- Hospital mortality was higher in the CABG+AVR group (8%) compared to isolated CABG (2%).
- One-year survival was lower in CABG+AVR (86%) versus isolated CABG (94%), but five-year survival was similar.
- Prophylactic AVR group (Group III) showed excellent long-term symptom-free survival despite a higher preoperative comorbidity risk profile.
Conclusions:
- In-hospital mortality is elevated for octogenarians undergoing combined CABG and AVR.
- Prophylactic AVR in octogenarians with moderate AS undergoing CABG is justified by excellent long-term symptom-free survival.
- The increased mortality in the prophylactic AVR group was associated with a higher preoperative comorbidity burden.
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