Combined Valve and Coronary Artery Bypass Procedures in Septuagenarians and Octogenarians: Results in 120 Patients

Tsai, Tsung Po; Matloff, Jack M.; Chaux, Aurelio; Kass, Robert M.; Lee, Myles E.; Czer, L.; DeRobertis, Michele; Gray, Richard

doi:10.1016/s0003-4975(10)64608-5

Cited by 64 publications

(11 citation statements)

References 13 publications

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“…9 We found no significant difference in mortality rates between isolated aortic valve replacement for aortic stenosis and coronary artery bypass grafting; both the aortic valve replacement patients who died were over 80 years of age. Mitral valve surgery carries a much higher risk than aortic valve replacement, particularly if there is mitral regurgitation secondary to papillary muscle rupture/dysfunction complicating ischaemic heart disease, with mortality rates around 20% for isolated mitral valve replacement9 and up to 50% if combined with coronary artery bypass grafting 21…”

Section: Discussionmentioning

confidence: 99%

Good outcomes from cardiac surgery in the over 70s

Zaidi

Fitzpatrick

Keenan

et al. 1999

Heart

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Objective-To determine the early mortality and major morbidity associated with cardiac surgery in the elderly. Design-Retrospective case record review study of 575 patients > 70 years old who underwent cardiac surgery at the Manchester Heart Centre between January 1990 and December 1996. Setting-Regional cardiothoracic centre. Subjects-Patients > 70 years old who underwent cardiac surgery. Main outcome measures-Comparison of 30 day mortality and incidence of major morbidity between patients > 70 years old and patients < 70 years old. Results-Of 4395 cardiac surgical operations, 575 operations (13.1%) were in patients aged > 70 years (mean (SD) 73.1 (3.2) years). The proportion of elderly patients rose progressively from 7.9% in 1990 to 16.5% in 1996. 334 patients (58.1%) had coronary artery bypass grafting alone, 91 patients (15.8%) had valve surgery alone, and 129 patients (22.4%) had combined valve surgery and bypass grafting. For isolated coronary artery bypass grafting, 30 day mortality in patients > 70 years was 3.9% compared with 1.3% in patients < 70 years (p < 0.001). 30 day mortality for isolated valve surgery in patients > 70 years was 7.7%. Isolated aortic valve replacement was the most common valvar procedure in patients > 70 years and carried the lowest mortality (4.3%). Additional coronary artery bypass grafting increased the mortality rate in patients > 70 years to 9.3% for all valve surgery and to 8.0% for aortic valve replacement. Major morbidity in patients > 70 years was low for all procedure types (stroke 1.9%, acute renal failure requiring dialysis 1.6%, perioperative myocardial infarction 0.5%). Conclusions-Early mortality and major morbidity is low for cardiac surgery in elderly patients. Concerns over the risk of cardiac surgery in the elderly should not prevent referral, and elderly patients usually do well. However, unconscious rationing of health care may aVect referral patterns, and studies that assess the cost eVectiveness of cardiac surgery versus conservative management in such patients are lacking. (Heart 1999;82:134-137)

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Section: Discussionmentioning

confidence: 99%

Good outcomes from cardiac surgery in the over 70s

Zaidi

Fitzpatrick

Keenan

et al. 1999

Heart

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“…5,9,19,20 These patients are at higher risk not only because of age, but also because of associated comorbidity. However, consideration for surgical intervention should not be made on the basis of age per se; instead, case selection should be based on life expectancy of each patient in terms of other disease factors.…”

Section: Operative Resultsmentioning

confidence: 99%

Aortic valve replacement in patients 70 years and older

Salazar

Torres

Barragán

et al. 2004

Clinical Cardiology

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SummaryBackground: Aortic valvular disease is the most common valvular lesion among elderly patients. Because of changing demographics, it has become increasingly frequent. Aortic valve replacement (AVR) is the only effective treatment for aortic valvular disease.Hypothesis: This study was undertaken to evaluate the results of AVR in an elderly population.Methods: Data were retrospectively analyzed in 117 consecutive patients (mean age 73.8 years) who underwent AVR between 1991 and 2002.Results: Pure or predominant severe aortic stenosis was present in 108 patients. Nine patients had severe aortic regurgitation. Before valve replacement, 62.4% of the patients were in New York Heart Association (NYHA) functional class III-IV. A bioprosthesis was implanted in 62.4% of the patients, and 37.6% received a mechanical valve. Concomitant cardiac surgical procedures were performed in 25 patients (coronary artery bypass graft in 22, mitral valve replacement in 3). There were 17 deaths, giving a perioperative mortality rate of 14.5%. Multivariate logistic regression showed that repeat surgery for bleeding, prolonged cardiopulmonary bypass time, postoperative respiratory failure, and postoperative acute renal insufficiency were significant independent predictors of operative mortality. Of the 100 hospital survivors, 78 were followed for a mean of 42.9 months. There were six deaths during followup; only two of these were cardiac related. Five-year actuarial survival for all patients and for hospital survivors were 70 and 91.1%, respectively. One year post surgery, all patients were in NYHA functional class I-II.

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“…In another report on combined mitral valve and coronary disease, it was con cluded that preoperativc NYHA functional class and emergency operations significantly influenced surgical survival [10], Yadav et al [14] have shown a 13% mortality when the mitral valve disease was ischemic in origin while there was no mortality when the origin was rheumatic disease. It has also been re ported that advanced age [14,15] and NYHA were the highest predictors for mortality [7], Very few reports of multiple valve replace ments combined with CABG are available in the literature. Atkins et al [16] have reported on their experiences in 33 consecutive pa tients with a mortality rate of 12.1%.…”

Section: Discussionmentioning

confidence: 99%

Combined Cardiac Surgery in Adults

Christenson¹,

Velebit²,

Maurice³

et al. 1996

Med Principles Pract

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A total of 127 patients underwent combined coronary artery and valvular operations at our institutions, between 1984 and 1993. Ninety patients underwent coronary artery bypass grafting (CABG) and simultaneous aortic valve replacement (AV), 30 patients had CABG and mitral valve repair or replacement (MV) and 7 patients had CABG combined with a double-valve operation. An average of 2.7 bypasses were done (range 1-7). Preoperatively, 97 patients (76%) were categorized in the New York Heart Association (NYHA) functional class 3 or 4. There were 18 emergency operations and 10 reoperative procedures. In 31 patients (24%) the preoperative left ventricular ejection fraction was less than 40%. The overall hospital mortality rate was 11.8% (15/127). The mortality group (n = 15) was compared to the group of hospital survivors (n = 112) and the following parameters were found to be significant risk factors for perioperative mortality: age > 65 years (p < 0.05), insulin-dependent diabetes mellitus (p < 0.02), generalized arteriosclerosis (p < 0.01), preoperative NYHA functional classes 3 and 4 (p < 0.02) and double-valve procedures (p < 0.004). Long-term follow-up revealed a 5-year survival rate of 71.5% for CABG + AV and 62.5% for CABG + MV. The 5-year event-free survival rates were 52.6 and 53.4%, respectively. This study shows that, even in high-risk patients, combined valve repair/replacement and CABG surgery can be performed successfully with good, long-term results.

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Combined Valve and Coronary Artery Bypass Procedures in Septuagenarians and Octogenarians: Results in 120 Patients

Cited by 64 publications

References 13 publications

Good outcomes from cardiac surgery in the over 70s

Good outcomes from cardiac surgery in the over 70s

Aortic valve replacement in patients 70 years and older

Combined Cardiac Surgery in Adults

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