Aortic valve replacement with and without combined coronary bypass grafts in very elderly patients: early and long-term results

Dell’Amore, Andrea; Aquino, Tommaso; Pagliaro, Marco; Lamarra, Mauro; Zussa, Claudio

doi:10.1093/ejcts/ezr029

Cited by 42 publications

(34 citation statements)

References 24 publications

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“…In contrast, some studies found that outcomes were the same or better after AVR with CABG compared with AVR alone [7][8][9]. Melby et al [13] found that concomitant CABG improved operative and long-term outcomes in elderly patients undergoing AVR.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies reported higher rates of operative mortality and morbidity in elderly patients after combined AVR and CABG compared with AVR alone [2][3][4][5][6]. In contrast, other studies reported similar outcomes after AVR with or without CABG [7][8][9]. All these studies reported comparisons between AVR alone vs combined AVR and CABG in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

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Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients

Fukui

Bando

Tanaka

et al. 2013

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES: Although the number of elderly patients undergoing combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is increasing, the early and mid-term outcomes of this combined procedure remain to be determined. We sought to elucidate the early and mid-term outcomes of elderly (≥75 years) vs non-elderly (<75 years) patients who underwent combined AVR and CABG. METHODS:Between September 2004 and September 2011, 259 patients underwent combined AVR and CABG at our institute, including 155 elderly patients (59.8%; Elderly group) with a mean age of 79.8 ± 3.6 years and 104 non-elderly patients (40.2%; Non-elderly group) with a mean age of 67.3 ± 5.8 years. Early and mid-term outcomes were compared, and multivariate analyses were performed to determine the risk factors for morbidity and mortality. The mean follow-up times were 33.1 ± 21.7 and 37.4 ± 22.2 months in the Elderly and Non-elderly groups, respectively. RESULTS:The mean number of anastomoses and the frequency of use of the internal thoracic artery were similar between the two groups. The use of a mechanical valve was less frequent in the Elderly group than in the Non-elderly group (11.6 vs 60.6%, P < 0.001). The Elderly and Non-elderly groups had similar rates of operative death (1.9 vs 1.0%, P = 0.651), early stroke (2.6 vs 1.0%, P = 0.651), 5-year overall survival (83.1 ± 4.8 vs 87.2 ± 5.2%, P = 0.358), 5-year freedom from cardiac death (92.3 ± 2.7 vs 94.8 ± 3.4%, P = 0.570) and 5-year freedom from stroke (94.0 ± 2.6 vs 99.0 ± 1.0%, P = 0.097). Cox proportional hazards analyses identified diabetes, creatinine level and EuroSCORE II, but not age, as independent predictors of overall mortality rate.CONCLUSIONS: Early and mid-term outcomes of combined AVR and CABG were similar between elderly and non-elderly patients. Older age was not a risk factor for mortality in patients undergoing combined AVR plus CABG, and this procedure should be recommended in properly selected elderly patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients

Fukui

Bando

Tanaka

et al. 2013

European Journal of Cardio-Thoracic Surgery

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“…Instead, they found that the urgency status, EF <35%, intraoperative variables (such as the clamping time and need for an intra-aortic balloon pump) and postoperative variables (such as prolonged ventilation, dialysis, postoperative myocardial infarction, and repeat thoracotomy for bleeding) had an influence on hospital mortality. 8) Although there have been few reports regarding AVR in Japanese elderly patients, Handa et al investigated 7883 patients undergoing isolated AVR in the Japan Adult Cardiovascular Surgery Database. They found that operative mortality andthe incidence of postoperative complications (stroke, respiratory problems, transient ischemic attack (TIA), renal failure, multiple organ failure, etc.)…”

Section: Discussionmentioning

confidence: 99%

Early and Long-Term Outcomes in Japanese Patients Aged 80 Years or Older Undergoing Conventional Aortic Valve Replacement

Sezai

Osaka

Yaoita

et al. 2015

ATCS

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In this study, we investigated the early and long-term results of conventional aortic valve replacement (AVR) in very old patients. Methods: Seventy-five patients with aortic stenosis underwent conventional AVR for patients aged 80 years.We examined early death and major adverse cardiovascular and cerebrovascular event (MACCE). Results: The operative mortality was 0% for isolated AVR and 19.2% for concomitant surgery. The postoperative survival rate and MACCE free-rate were no significant differences between the isolated AVR and the concomitant surgery. Univariate analysis confirmed that cardiac dysfunction, severe chronic kidney disease (CKD), hemodialysis, + coronary artery bypass grafting, and norepinephrine use were risk factor of early death. Univariate analysis confirmed that severe CKD, BNP >1000 pg/ml, aortic cross clamping time (ACCT) >180 min, and non-use carperitide and multivariate analysis confirmed that ACCT >180 min, and non-use carperitide were risk factor of MACCE. Conclusions: This study showed that the results of conventional AVR in very old patients were not satisfactory. However, the results obtained with isolated AVR were favorable with no operative deaths. The present study demonstrated that preoperative cardiac function, preoperative renal function, and operative factors have an important impact on early mortality and MACCE.

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“…Among patients who underwent AVR in combination with CABG, the history of myocardial infarction was more often recorded, neurological deficit and multifocal atherosclerosis; in the intraoperative period, the time of aortic clamping was higher, and in the postoperative period, the low cardiac output syndrome was more often registered (early outcomes -18.6% in group AVR+CABG, compared with 4.8% in group AVR). Differences in results, according to the authors, are due to the initial clinical characteristics of patients (17). In Norway, during the same period, the proportion of patients with ischemic and degenerative mitral insufficiency in whom the CABG and MVR or mitral valve repair were simultaneously performed was 33% while, 13% of patients simultaneously underwent CABG and AVR (18).…”

Section: Vhd Surgery Combined With Cabg In Elderlymentioning

confidence: 94%

Surgical treatment of acquired valvular heart disease in elderly patients

Urmanbetov¹,

Tukusheva²,

Kaliev³

et al. 2018

HVT

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Aortic valve replacement with and without combined coronary bypass grafts in very elderly patients: early and long-term results

Cited by 42 publications

References 24 publications

Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients

Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients

Early and Long-Term Outcomes in Japanese Patients Aged 80 Years or Older Undergoing Conventional Aortic Valve Replacement

Surgical treatment of acquired valvular heart disease in elderly patients

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