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Interaction of age and coronary disease after valve replacement: implications for valve selection
E L Jones1, W S Weintraub, J M Craver
1Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Insights
Coronary artery disease significantly impacts survival after aortic or mitral valve replacement, especially in older patients and those undergoing emergency procedures. Bioprosthetic valves may be justified for patients aged 70+ with CAD.
Area of Science:
- Cardiovascular Surgery
- Clinical Outcomes Research
- Geriatric Cardiology
Background:
- Coronary artery disease (CAD) is a significant comorbidity in patients undergoing valve replacement surgery.
- The interplay between patient age, CAD, and outcomes after aortic valve replacement (AVR) or mitral valve replacement (MVR) requires further elucidation.
Purpose of the Study:
- To examine the influence of patient age and coronary artery disease (CAD) on survival following aortic (AVR) or mitral (MVR) valve replacement.
- To assess the impact of concomitant coronary artery bypass grafting (CABG) and emergency operative status on survival outcomes.
Main Methods:
- Retrospective analysis of 3,644 patients undergoing AVR or MVR between 1974 and 1991.
- Inclusion of patients with and without coronary artery disease (CAD), with or without coronary artery bypass grafting (CABG).
- Utilized Cox proportional hazard models to analyze patient survival and valve survival.
Main Results:
- Coronary artery disease (CAD) significantly reduced median survival for all age groups undergoing AVR or MVR.
- Patients aged 60-69 undergoing MVR with CAD experienced the most profound survival reduction when CABG was not performed.
- Emergency operative status was linked to reduced survival, particularly in MVR patients with CAD.
- For patients 70 and older with CAD undergoing AVR or MVR, median survival was significantly reduced (5.5 vs. 8.1 years), suggesting bioprosthetic valve use.
Conclusions:
- Coronary artery disease (CAD) is a critical determinant of long-term survival after valve replacement surgery.
- Age and the presence of CAD significantly modify survival outcomes, with older patients and those with CAD facing poorer prognoses.
- Findings support the consideration of bioprosthetic valves in elderly patients (70+) with CAD undergoing valve replacement.
Abstract:
The interaction of patient age and the presence of coronary artery disease (CAD) and its influence on survival were examined in 3,644 patients undergoing either aortic (AVR) or mitral (MVR) valve replacement with or without coronary artery bypass grafting (CABG) between 1974 and 1991. Emergency procedures were performed much more frequently in those undergoing MVR and CABG than in those undergoing AVR and CABG (18.8% and 6.7%, respectively). The adverse effect of CAD on median survival for patients of all ages undergoing either AVR or MVR was statistically significant (AVR without CAD 11.8 versus 8.7 years with CAD; MVR without CAD 12.7 versus 7.3 years with CAD; p < 0.0001). Survival in patients younger than 70 years without CABG who underwent either AVR or MVR was quite good (< 60 years: AVR, > 14 years; MVR, 15.4 years; 60 to 69 years: AVR, 10.4 years; MVR, 11.4 years). The most profound effect of CAD on patient survival after valve replacement was observed in patients 60 to 69 years of age who underwent MVR, in whom the median survival without CABG was 11.4 years versus 5.5 years with CABG (p < 0.0001). An emergency operative status was associated with a reduced early and late survival for those patients undergoing MVR, particularly those with CAD. By relating the Cox proportional hazard models for valve survival to patient survival, we found that, in those patients 70 years and older with and without CAD who underwent either AVR or MVR, the median patient survival was reduced sufficiently (5.5 versus 8.1 years) to justify use of a bioprosthetic valve.(ABSTRACT TRUNCATED AT 250 WORDS)