Perioperative predictors of midterm survival after aortic valve replacement

Abstract

5-year survival among octogenarians was 59.2% with an observed 30-day mortality of 1% for aortic valve replacement and 3% for aortic valve replacement with coronary artery bypass. Kaplan-Meier survival analysis showed that age ≥80 years, New York Heart Association functional class III/IV, and left ventricular ejection fraction <35% were significantly associated with increased midterm mortality. Cox regression modeling demonstrated that age ≥80 years was the only significant independent factor associated with midterm mortality; older patients had a 3-fold increase in mortality (adjusted hazard ratio = 3.231, 95% confidence interval: 1.764-5.920, p < 0.0001). While hospital and 30-day mortality were not statistically different between age groups, age ≥80 years was the most powerful predictor of midterm death. These results support early aortic valve replacement with or without coronary artery bypass in aortic stenosis management.

The impact of coronary artery bypass grafting added to aortic valve replacement on long-term outcomes in octogenarian patients: a reconstructed time-to-event meta-analysis

“…Seven studies reported data on re-thoracotomy for postoperative bleeding [ 3 , 4 , 6 , 15–17 , 20 , 23 ]. The OR did not reveal significant difference between the 2 groups (OR = 0.84; 95% CI = 0.57–1.23; P = 0.37) with no relevant heterogeneity ( I 2 = 21%; Supplementary Material, Fig.…”

“…While in-hospital mortality is increased by the concomitant CABG surgery, as recognized by EuroSCORE and Society of Thoracic Surgeon score, the impact on long-term outcomes is debated. Some studies have reported acceptable and comparable long-term results in those patients who received either i-SAVR or CABG combined with SAVR [ 2 , 3 ], whereas other authors have reported conflicting outcomes, with some studies showing better long-term survival in i-SAVR patients [ 4 ] while others reporting longer-term benefit in CABG+SAVR patients [ 5 , 6 ]. To the best of our knowledge, no randomized control trials or meta-analyses related to the impact on long-term of CABG added to SAVR in octogenarians are available.…”

The early and long-term outcomes of coronary artery bypass grafting added to aortic valve replacement compared to isolated aortic valve replacement in elderly patients: a systematic review and meta-analysis

“…A total of 2046 titles and abstracts were identified, of which 57 were considered potentially relevant and for the meta-analysis and retrieved as full-text. After evaluating the full-text articles, 44 studies [ 5 – 21 , 27 – 53 ] fulfilled the eligibility criteria and were included in the final analysis. All included studies were observational and retrospective in design, an no randomized clinical trials or prospective studies were identified.…”

“…Twenty-two studies [ 5 , 7 , 9 , 11 , 13 , 17 – 21 , 27 , 29 , 34 , 38 , 39 , 41 , 45 , 50 – 53 ] reported long-term survival comparison between the two surgical interventions with a mean follow-up ranging from 2.1 years [ 27 ] to 9.5 years [ 45 ]. The weighted mean follow-up was 3.2 years.…”

“…Other authors [ 11 – 16 ] have reported unfavorable early outcome in those patients who underwent simultaneous SAVR and CABG. The results are still debated regarding long-term outcomes, as some studies have reported acceptable and comparable long-term outcomes [ 17 , 18 ], whereas other authors have reported conflicting results, with some studies showing better long-term survival in i-SAVR patients [ 19 ] and others reporting better long-term outcomes in SAVR plus CABG patients [ 20 , 21 ]. No randomized control trials are available and, to the best of our knowledge, no meta-analyses have addressed the impact of concomitant CABG and SAVR in elderly patients.…”