Outcome after aortic valve replacement in octogenarians

Chiappini, Bruno; Camurri, Nicola; Loforte, Antonio; Marco, Luca Di; Bartolomeo, Roberto Di; Marinelli, Giuseppe

doi:10.1016/j.athoracsur.2003.12.060

Cited by 142 publications

(105 citation statements)

References 9 publications

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“…Among the 53 patients who developed postoperative arrhythmias, 48 had atrial fibrillation or supraventricular tachycardia that was rapidly treated with either intravenous antiarrhythmic agents or cardioversion. The incidence of other postoperative complications, such as stroke, dialysis, myocardial infarction, or reoperation, was comparable with other recent reports [3][4][5]11]. In particular, our stroke rate (2%) was low.…”

Section: Operative Mortality and Morbiditysupporting

confidence: 91%

“…Poor left ventricular function was also predictive of hospital death in several studies [4,5,10,11]. Elayada et al [10] also found hypertension and concomitant surgical procedures to be associated with early mortality.…”

Section: Operative Mortality and Morbiditymentioning

confidence: 97%

“…Recently, Chiappini et al [5] and Collart et al [11], respectively, reported a 8.5% and a 8.8% operative mortality after AVR in octogenarians.…”

Section: Operative Mortality and Morbiditymentioning

confidence: 99%

“…Early reports of AVR in elderly patients showed high operative mortality rates; however, more recent reports have shown mortality rates of 2-10% for isolated AVR [3][4][5]10,11]. Recently, Chiappini et al [5] and Collart et al [11], respectively, reported a 8.5% and a 8.8% operative mortality after AVR in octogenarians.…”

Section: Operative Mortality and Morbiditymentioning

confidence: 99%

“…Recent reports reveal that cardiac operations for selected elderly individuals who have otherwise good physical and mental health can improve mortality, morbidity, and quality of life [3][4][5], but long-term results are incomplete, especially for valve disease. While previously uncommon, we have observed in our center, during the last 15 years, a significant increase in the number of patients aged 80 years and more who are being referred for aortic valve surgery, and this despite a context of growing control of health care expenditures, where one might think that expensive procedures, such as cardiac operations, would be limited in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

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Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Kolh¹,

Kerzmann

Honoré³

et al. 2007

European Journal of Cardio-Thoracic Surgery

184

118

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long-term results Aortic valve surgery in octogenarians: predictive factors for operative and This information is current as of April 2, 2007http://ejcts.ctsnetjournals.org/cgi/content/full/31/4/600 located on the World Wide Web at:The online version of this article, along with updated information and services, is AbstractObjective: To assess factors influencing operative and long-term outcome in octogenarians undergoing aortic valve surgery (AVR). Methods: Records of 220 consecutive octogenarians having AVR between 1992 and 2004 were reviewed, and follow-up obtained (99% complete). Of the group (mean age: 82.8 years; 174 females), 142 patients (65%) were in New York Heart Association (NYHA) class III-IV, 22 (10%) had previous myocardial infarction, 11 (5%) had previous coronary artery bypass grafting (CABG), and 8 (4%) had percutaneous aortic valvuloplasty. There were 44 urgent procedures (20%), and additional CABG was performed in 58 patients (26%). Results: Operative mortality was 13% (9% for AVR, 24% for AVR + CABG). Among the 29 patients who died, 14 (48%) were operated on urgently (32% mortality for urgent procedures). Causes of hospital death were respiratory insufficiency or infection in 16 patients (16/29 = 55%), myocardial infarction in 8 (28%), stroke in 2 (7%), sepsis in 2 (7%), and renal failure in 1 (3%). Significant postoperative complications were atrial fibrillation in 48 patients (22%), respiratory insufficiency in 46 (21%), permanent atrio-ventricular bloc in 12 (5%), myocardial infarction in 10 (5%), hemodialysis in 4 (2%), and stroke in 4 (2%). Mean hospital and intensive care unit (ICU) stays were 17.6 AE 5.2 and 6.9 AE 3.4 days, respectively. Multivariate predictors ( p < 0.05) of hospital death were urgent procedure, associated CABG, NYHA class IV, and percutaneous aortic valvuloplasty. Age, associated CABG, and urgent procedure were predictors of prolonged ICU stay. Mean follow-up was 58.2 months and actuarial 5-year survival was 73.2 AE 6.9%. Age, preoperative myocardial infarction, urgent procedure, and duration of ICU stay were independent predictors of late death. Among 130 patients alive at follow-up, 91% were angina free and 81% in class I-II. Conclusions: AVR in octogenarians can be performed with acceptable mortality, although significant morbidity. These results stress the importance of early operation on elderly patients with aortic valve disease, avoiding urgent procedures. Associated coronary artery disease is a harbinger of poor operative outcome. Long-term survival and functional recovery are excellent. #

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Section: Operative Mortality and Morbiditysupporting

confidence: 91%

Section: Operative Mortality and Morbiditymentioning

confidence: 97%

“…Recently, Chiappini et al [5] and Collart et al [11], respectively, reported a 8.5% and a 8.8% operative mortality after AVR in octogenarians.…”

Section: Operative Mortality and Morbiditymentioning

confidence: 99%

Section: Operative Mortality and Morbiditymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Kolh¹,

Kerzmann

Honoré³

et al. 2007

European Journal of Cardio-Thoracic Surgery

184

118

View full text Add to dashboard Cite

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Meta‐analysis of complications in aortic valve replacement: Comparison of Medtronic‐Corevalve, Edwards‐Sapien and surgical aortic valve replacement in 8,536 patients

Jilaihawi

Chakravarty

Weiss³

et al. 2012

Cathet Cardio Intervent

115

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Discharge disposition of older patients undergoing trans‐catheter aortic valve replacement and its impact on survival

Okoh

Haik

Singh

et al. 2019

Cathet Cardio Intervent

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Background Patients undergoing transcatheter aortic valve replacement (TAVR) are likely to be discharged to a location other than home. We aimed to assess the association between discharge disposition after TAVR and patient survival at 1 year. Methods Patients admitted from home and survived till discharge after TAVR were divided into two groups based on discharge disposition (home discharge vs. non‐home discharge). Pre‐operative factors predicting the odds of not being discharged home were identified by using multivariable logistic regression analysis. Study patients were matched one‐to‐one via a propensity scoring method. Differences in procedural outcomes were compared. Survival of both unmatched and matched pairs was evaluated by using the Kaplan‐Meier method with the Kleine‐Moesch‐Berger stratified log‐rank test. Results Out of 1,160 TAVR patients, 851 were admitted from home and survived till discharge. The incidence non‐home discharge was 19% (n = 159). Factors that were significantly associated with non‐home discharge were older age, non‐transfemoral approach, female sex, frailty status, history of chronic lung disease, pacemaker placement and insulin‐dependent diabetes mellitus. One‐to‐one propensity score matching resulted in 141 patient pairs with similar age, operative risk, frailty and functional status. At 1‐year follow‐up, all‐cause mortality rates were significantly higher in the non‐home group than their home counterparts (18% vs. 3%, P = 0.006; stratified log rank test: P = 0.006). Conclusions A considerable number of TAVR patients are discharged to a location other than home after the procedure. Not being discharged home after TAVR is associated with a high mortality risk at 1 year.

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Outcome after aortic valve replacement in octogenarians

Cited by 142 publications

References 9 publications

Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Meta‐analysis of complications in aortic valve replacement: Comparison of Medtronic‐Corevalve, Edwards‐Sapien and surgical aortic valve replacement in 8,536 patients

Discharge disposition of older patients undergoing trans‐catheter aortic valve replacement and its impact on survival

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