Heart valve surgery in octogenarians: operative and long-term results

Abstract

This study was performed to evaluate surgical outcomes in octogenarian patients undergoing valve surgery. Sixty patients (mean age 82.3 ± 1.9 years) who underwent valve surgery were reviewed. Aortic valve disease was found in 65% of the patients. Preoperatively, 20% of the patients were in NYHA class IV. An urgent operation and concomitant coronary artery bypass grafting were performed in ten patients each. A bioprosthetic valve was exclusively used for valve replacement except in two patients. Mitral valve repair was done in seven patients. Operative mortality was 13.3% for the period. No risk factors for operative mortality were detected by multivariate analysis; however, urgent operation, preoperative NYHA class IV, preoperative renal dysfunction, perioperative use of an intra-aortic balloon pumping, and prolonged cardiopulmonary bypass time had significant effects on operative mortality. The actuarial survival rate at 1 and 3 years after surgery was 82.6 and 71.5%, respectively, and 97.6% of late survivors reported that their activity level was equal to or better than the preoperative level. Valve surgery can be performed in octogenarian patients with acceptable mortality, good long-term results, and good quality of life. Early referral to surgery should be important to obtain a better postoperative outcome.

There is no significant difference in the operative risk between octogenarians compared with patients younger than 60 years in cardiac surgery*

“…However, the postoperative outcome in group Idid not significantly differ from those reported by other authors [7][8][9][10][11][12][13][14][15][16][17][18].…”

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

“…3) Aoyagi et al studied 60 octogenarians undergoing heart valve surgery and reported that urgent operation, preoperative NYHA class IV, preoperative renal dysfunction, perioperative use of an intra-aortic balloon pump, and prolonged cardiopulmonary bypass had an influence onoperative mortality. 9) While the present study suggested that the indications for surgery should not be determined by age alone, severe CKD was found to be a strong contraindication with a 6-month mortality rate of 57.1%. Thus, TAVI should probably be considered for dialysis patients although it is not indicated for these patients at present.…”

Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?

“…6) transcatheter aortic valve replacement (TAVR) proved this new approach as an effective, alternative treatment to conventional SAVR in selected patient populations. 7,8) An evaluation of outcomes after SAVR in high-risk surgical patients is required in order to identify the best option for each patient population.…”