Aortic Valve Replacement in Octogenarians: Are Concomitant Coronary Artery Bypass Grafting Operations Predictive Factors?

Abstract

Because of increasing life expectancy and the high incidence of aortic stenosis(AS)in high-age groups, aortic valve replacement(AVR)for severe AS has become more frequent in recent years. The purpose of this study is to analyze operative outcome in octogenarians and evaluate the effect of concomitant coronary artery bypass grafting(CABG)for coronary artery disease. Between 2003 and 2010, 77 patients(18 men)aged over 80 years(80∼88 years ; mean age, 82.7 years)underwent AVR (bioprosthesis in 75 cases). Of these patients, 43.4% were categorized in New York Heart Association (NYHA)class III∼IV and 41% had a history of congestive heart failure. In addition, 26 patients(33.8%) underwent associated CABG operations(1-4 grafts ; mean, 1.8 grafts)with AVR. Operative mortality was 5.2%(4 patients). The operation time, cardiopulmonary bypass time, and aortic clamp time were significantly longer and amount of blood transfusion needed was greater in the concomitant CABG group than in the AVR-alone group. However, there were no differences between the groups with regard to intensive care unit(ICU)stay, postoperative hospital stay, operative mortality, and long-term survival. The outcome of AVR in octogenarians was good even in concomitant CABG patients. Aggressive surgical treatment of both aortic valve disease and concomitant coronary artery disease is warranted for most patients, despite advanced age.