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Long-Term Survival among Octogenarians Undergoing Aortic Valve Replacement with or without Simultaneous Coronary

Hannah Masraf1, Davorin Sef1, Sirr Ling Chin1

  • 1Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK.

Journal of Clinical Medicine
|July 29, 2023
PubMed

Insights

Adding coronary artery bypass grafting (CABG) to aortic valve replacement (AVR) in octogenarians did not impact long-term survival, but increased in-hospital mortality. Heart team discussion is crucial for these complex cases.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Geriatric Medicine

Background:

  • The necessity and impact of combining coronary artery bypass grafting (CABG) with aortic valve replacement (AVR) in elderly patients (octogenarians) remain subjects of ongoing debate.
  • This study investigates the characteristics and long-term survival outcomes for octogenarians undergoing isolated AVR versus those receiving both AVR and CABG.

Purpose of the Study:

  • To compare the long-term survival and postoperative outcomes of octogenarians undergoing isolated aortic valve replacement (AVR) versus those undergoing AVR combined with coronary artery bypass grafting (CABG).
  • To identify predictors of mortality in both groups and assess whether concomitant CABG independently affects long-term survival.

Main Methods:

  • Retrospective analysis of octogenarian patients undergoing AVR with or without CABG between 2000 and 2022 at a tertiary cardiac center.
  • Exclusion of patients with redo procedures, emergent surgeries, or other concomitant operations.
  • Primary endpoints included 30-day and long-term survival; secondary endpoints covered early postoperative outcomes and survival determinants, analyzed using logistic and Cox regression models.

Main Results:

  • A total of 1011 patients underwent isolated AVR and 1055 underwent AVR + CABG. 30-day and long-term survival rates were comparable between the two groups.
  • Median postoperative survival was similar (7.1 years for AVR vs. 6.6 years for AVR + CABG; p=0.21).
  • Concomitant CABG was not an independent predictor of adverse long-term survival (HR: 0.89; p=0.09), though it was associated with higher in-hospital mortality.

Conclusions:

  • The addition of CABG to AVR in octogenarians does not significantly alter long-term survival outcomes.
  • Octogenarians undergoing AVR + CABG experienced higher in-hospital mortality compared to those undergoing isolated AVR.
  • Individualized treatment decisions for these patients should be made through thorough heart team consultations.
Abstract

Keywords:
aortic valve replacementcoronary artery bypass graftinglong-term survivaloctogenarians

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