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Aortic valve replacement with or without concomitant coronary artery bypass grafting in very elderly patients aged

Kazuyoshi Takagi1, Koichi Arinaga2, Tohru Takaseya2

  • 1Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan. takagi13@me.com.

Heart and Vessels
|May 13, 2020
PubMed

Insights

Aortic valve replacement (AVR) with or without coronary artery bypass grafting (CABG) is safe for patients 85 and older. Outcomes, including survival, were similar between groups, demonstrating acceptable early and long-term results.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Geriatric Medicine

Background:

  • Degenerative aortic stenosis is a prevalent condition in the aging population.
  • While less invasive options exist, open-heart surgery remains crucial for elderly patients with complex cardiac conditions.
  • Severe coronary artery disease often necessitates combined procedures during aortic valve replacement.

Purpose of the Study:

  • To analyze the outcomes of very elderly patients (≥85 years) undergoing aortic valve replacement (AVR).
  • To compare outcomes between isolated AVR and AVR combined with coronary artery bypass grafting (CABG) in this age group.

Main Methods:

  • Retrospective analysis of 29 patients aged ≥85 years undergoing AVR.
  • Patients were divided into two groups: AVR with CABG (Group AC, n=11) and isolated AVR (Group A, n=18).
  • Outcomes assessed included operative mortality, morbidity, length of stay, and long-term survival rates.

Main Results:

  • Aortic cross-clamp time was significantly longer in Group AC (126.5 min) compared to Group A (96.9 min).
  • Major morbidity rate was higher in Group AC (36%) versus Group A (6%).
  • No significant differences were observed in 30-day mortality, hospital mortality, ICU/hospital stay, or long-term survival rates between the groups.

Conclusions:

  • Aortic valve replacement with or without CABG can be safely performed in carefully selected very elderly patients.
  • The procedure offers acceptable early and long-term results for patients aged 85 and above.
  • Combined AVR and CABG demonstrates comparable outcomes to isolated AVR in terms of mortality and survival in this population.

Keywords:
Aortic valve replacementConcomitant coronary artery bypass graftingOutcomeVery elderly patients

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