Combined cardiac surgical procedures in octogenarians: operative outcome

Gulbins, H; Malkoc, Aldin; Ennker, Jürgen

doi:10.1007/s00392-007-0615-8

Cited by 24 publications

(12 citation statements)

References 14 publications

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“…13,29,30 Our series is consistent with these reports, with 6-year survival of 54.7% in 16 in their series of 196 octogenarians found that simultaneous CABG had no effect on 60-day mortality (relative risk, 0.96; 95% CI, 0.54 to 1.70) and a statistically insignificant increased median late survival: 7.4 years (95% CI, 6.4 to 13.3) for patients after AVRϩCABG versus 6 years (95% CI, 5.4 to 8.9) for patients after AVR. Our present findings are similar to those of Gulbins et al, 31 who showed that in-hospital mortality rates were higher among patients having AVRϩCABG versus those undergoing AVR (10% versus 4%, PϽ0.05). Gulbins et al 31 suggested that the additional risk of mortality was acceptable, given a lower observed mortality rate relative to that predicted through the use of Euroscore.…”

Section: Discussionsupporting

confidence: 92%

“…Our present findings are similar to those of Gulbins et al, 31 who showed that in-hospital mortality rates were higher among patients having AVRϩCABG versus those undergoing AVR (10% versus 4%, PϽ0.05). Gulbins et al 31 suggested that the additional risk of mortality was acceptable, given a lower observed mortality rate relative to that predicted through the use of Euroscore.…”

Section: Discussionsupporting

confidence: 92%

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Long-Term Survival of the Very Elderly Undergoing Aortic Valve Surgery

et al. 2009

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Background— Increasing numbers of the very elderly are undergoing aortic valve procedures. We describe the short- and long-term survivorship for this cohort. Methods and Results— We conducted a cohort study of 7584 consecutive patients undergoing open aortic valve surgery without (51.1%; AVR) or with (48.9%; AVR + CABG) concomitant coronary artery bypass graft surgery between November 10, 1987 through June 30, 2006. Patient records were linked to the Social Security Administration’s Death Master File. Survivorship was stratified by age and concomitant CABG surgery. During 39 835 person-years of follow-up, there were 2877 deaths. Among AVR, there were 3304 patients <80 years of age, 419 patients 80 to 84 years, and 156 patients ≥85 years (24 patients >90 years). Among AVR+CABG patients, there were 2890 patients <80 years of age, 577 patients 80 to 84 years, and 238 patients ≥85 years (22 patients >90 years). Median survivorship for patients undergoing isolated AVR was 11.5 years (<80 years), 6.8 years (80 to 84 years), 6.2 years (≥85 years); for patients undergoing AVR+CABG, median survivorship was 9.4 years (<80 years), 6.8 years (80 to 84 years), and 7.1 years (≥85 years). Among both procedures, adjusted survivorship was significantly different across strata of age ( P <0.001). These findings are similar to life expectancy of the general population from actuarial tables: 80 to 84 years (7 years) and ≥85 years (5 years). Conclusions— Survivorship among octogenarians is favorable, with more than half the patients surviving more than 6 years after their surgery. Concomitant CABG surgery does not diminish median survivorship among patients >80 years of age.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Long-Term Survival of the Very Elderly Undergoing Aortic Valve Surgery

et al. 2009

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“…Table 4 presents the in-hospital mortality rates of high-risk patients undergoing SAVR. The 30-day mortality rate of 9.6% observed in TAVI patients in our study is encouraging in light of the reported inhospital mortality rates of selected octogenarians (4.6% to 13.5%) [4][5][6][7][8][9][10][11] , patients with left ventricular dysfunction (6% to 33%) 12,13,[26][27][28][29][30][31] and patients with high logistic EuroSCORES (7.8%) undergoing surgical aortic valve replacement 32 . While surgical heart valve replacement remains the standard of care, several studies have demonstrated that 30% to 60% of patients with symptomatic severe aortic valve stenosis are denied or not referred for surgery [33][34][35][36] .…”

Section: Discussionmentioning

confidence: 62%

“…Contemporary studies indicate that the 30-day mortality rate following TAVI is 8% to 12% [1][2][3] . Following SAVR, the 30-day mortality rate in high-risk patient subsets was reported to be between 4.6% to 13.5% for octogenarians [4][5][6][7][8][9][10][11] and 6% to 33% for patients with left ventricular dysfunction 12,13 . To our knowledge, direct comparisons between TAVI and SAVR are not yet available.…”

Section: Introductionmentioning

confidence: 99%

A comparison of patient characteristics and 30-day mortality outcomes after transcatheter aortic valve implantation and surgical aortic valve replacement for the treatment of aortic stenosis: a two-centre study

Piazza¹,

Gameren²,

Jüni³

et al. 2009

EuroIntervention

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Aims: It is unclear whether transcatheter aortic valve implantation (TAVI) addresses an unmet clinical need for those currently rejected for surgical aortic valve replacement (SAVR) and whether there is a subgroup of high-risk patients benefiting more from TAVI compared to SAVR. In this two-centre, prospective cohort study, we compared baseline characteristics and 30-day mortality between TAVI and SAVR in consecutive patients undergoing invasive treatment for aortic stenosis. Methods and results: We pre-specified different adjustment methods to examine the effect of TAVI as compared with SAVR on overall 30-day mortality: crude univariable logistic regression analysis, multivariable analysis adjusted for baseline characteristics, analysis adjusted for propensity scores, propensity score matched analysis, and weighted analysis using the inverse probability of treatment (IPT) as weights. A total of 1,122 patients were included in the study: 114 undergoing TAVI and 1,008 patients undergoing SAVR. The crude mortality rate was greater in the TAVI group (9.6% vs. 2.3%) yielding an odds ratio [OR] of 4.57 (95%-CI 2.17-9.65). Compared to patients undergoing SAVR, patients with TAVI were older, more likely to be in NYHA class III and IV, and had a considerably higher logistic EuroSCORE and more comorbid conditions. Adjusted OR depended on the method used to control for confounding and ranged from 0.60 (0.11-3.36) to 7.57 (0.91-63.0). We examined the distribution of propensity scores and found scores to overlap sufficiently only in a narrow range. In patients with sufficient overlap of propensity scores, adjusted OR ranged from 0.35 (0.04-2.72) to 3.17 (0.31 to 31.9). In patients with insufficient overlap, we consistently found increased odds of death associated with TAVI compared with SAVR irrespective of the method used to control confounding, with adjusted OR ranging from 5. 88 (0.67-51.8) to 25.7 (0.88-750). Approximately one third of patients undergoing TAVI were found to be potentially eligible for a randomised comparison of TAVI versus SAVR. Conclusions: Both measured and unmeasured confounding limit the conclusions that can be drawn from observational comparisons of TAVI versus SAVR. Our study indicates that TAVI could be associated with either substantial benefits or harms. Randomised comparisons of TAVI versus SAVR are warranted.

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“…Gulbins et al [18 ]also observed higher mortality rates in patients undergoing AVR/CABG compared to those undergoing either AVR or CABG alone, concluding that the additional risk of mortality was real, but actually lower than that predicted, based on the EuroSCORE. Although combined AVR and CABG does carry with it a significantly higher mortality risk in the immediate postoperative period, this appears primarily related to the increased complexity of the procedure rather than something intrinsic to the patient selection process, as similar preoperative comorbidities and postoperative complications have been present in patients undergoing AVR alone, CABG alone or combined procedures (table 7) [9,17].…”

Section: Discussionmentioning

confidence: 99%

Aortic Valve Replacement with and without Coronary Artery Bypass Graft Surgery in Octogenarians: Is It Safe and Feasible?

Abel

Rogal²,

Burns³

et al. 2013

Cardiology

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Introduction: Octogenarians are often denied complex surgical intervention. We evaluated the rationality of this bias by comparing the outcomes of octogenarians undergoing aortic valve replacement (AVR) with or without coronary artery bypass grafting (CABG), to those of younger patients. Methods: Data on 476 patients (≥80 years) who underwent AVR or AVR/CABG were compared to the Society of Thoracic Surgeons (STS) database. Results: One hundred and seventeen octogenarians underwent AVR and 263 underwent AVR/CABG. Preoperative comorbidity rates were similar between these 2 respective groups, except for diabetes mellitus (18.8 vs. 30.4%, p = 0.02), previous cardiac stent placement (5.1 vs. 17.9%, p = 0.0006) and prior CABG (8.5 vs. 0.8%, p = 0.0002) and mortality did not differ significantly (5.1 vs. 7.6%, p = 0.51). Multivariate analysis identified preoperative chronic renal failure [odds ratio (OR) = 0.09, p < 0.048], postoperative arrhythmia (OR = 0.29, p < 0.022), sepsis (OR = 37.38, p < 0.000), pneumonia (OR = 8.29, p < 0.038) and renal failure (OR = 10.16, p < 0.000) with increased rates of inhospital mortality in AVR alone and AVR/CABG. Conclusion: AVR alone or AVR/CABG can be safely performed in patients ≥80 years with acceptable morbidity/mortality rates. An age of ≥80 years is not an independent risk factor predictive of increased inhospital mortality.

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Combined cardiac surgical procedures in octogenarians: operative outcome

Cited by 24 publications

References 14 publications

Long-Term Survival of the Very Elderly Undergoing Aortic Valve Surgery

Long-Term Survival of the Very Elderly Undergoing Aortic Valve Surgery

A comparison of patient characteristics and 30-day mortality outcomes after transcatheter aortic valve implantation and surgical aortic valve replacement for the treatment of aortic stenosis: a two-centre study

Aortic Valve Replacement with and without Coronary Artery Bypass Graft Surgery in Octogenarians: Is It Safe and Feasible?

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