Background: This study analyzed morbidity, mortality, and quality of life after aortic valve replacement with mechanical and biologic prostheses in octogenarian patients. Methods: A retrospective analysis was performed in 345 consecutive patients, mean age of 82 ± 2 years (range, 80 to 92), who had aortic valve replacement from May 1991 to April 2005. A bioprosthesis (group I) was used in 200 patients (58%), and 145 (42%) received a mechanical prosthesis (group II). Associated cardiac procedures were done in 211 patients (61%), of which 71% were coronary artery bypass grafting. Patients had symptomatic aortic stenosis (84.3%) or associated aortic insufficiency; 88% were in New York Heart Association (NYHA) class III or IV. The mean preoperative aortic valve gradient was 62 ± 16 mm Hg (range, 25 to 122 mm Hg). The mean left ventricular ejection fraction was good (0.52 ± 0.12); 30 patients (8.7%) had an ejection fraction of less than 0.30. Results: The in-hospital mortality rate was 7.5% (26 patients); 17 (8.5%) in group I and 9 (6.2%) in group II (p = 0.536) Significant predictors of operative mortality were preoperative renal insufficiency (blood creatinine > 2.00 mg/mL) and need for urgent operation. Mean follow-up, complete at 100%, was 40 ± 33 months (range, 1 to 176 months). Long-term follow-up, using Kaplan-Meier analysis, showed an overall survival of 61% at 5 years and 21% at 10 years; survival by type of prosthesis was significantly higher with mechanical prostheses (log-rank p = 0.03). Freedom from cerebrovascular events (thromboembolic/hemorrhagic) at 5 and 10 years was 89% and 62% in the mechanical group and 92% and 77% in the biologic group (p = 0.76). Postoperative NYHA functional class was I or II in 96% of patients. Quality-of-life scores were excellent considering the age of the patients. No differences were found between the two groups. Conclusions: Surgical treatment for symptomatic aortic stenosis in octogenarians has an acceptable operative risk with excellent long-term results and good quality of life. In this cohort, survival rate is slightly but significantly higher with mechanical prostheses.
Aortic valve replacement in octogenarians: is biologic valve the unique solution? / C. de Vincentiis, A.B. Kunkl, S. Trimarchi, P. Gagliardotto, A. Frigiola, L. Menicanti, M. Di Donato. - In: ANNALS OF THORACIC SURGERY. - ISSN 0003-4975. - 85:4(2008 Apr), pp. 1296-1301.
|Titolo:||Aortic valve replacement in octogenarians: is biologic valve the unique solution?|
KUNKL, ALESSIA BARBARA (Secondo)
|Parole Chiave:||quality-of-life; cardiac-surgery; heart-valve; elderly-patients; greater-than-or-equal-to-80 years; risk-factors; survival; outcomes; age; bioprostheses|
|Settore Scientifico Disciplinare:||Settore MED/23 - Chirurgia Cardiaca|
Settore MED/22 - Chirurgia Vascolare
|Data di pubblicazione:||apr-2008|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.athoracsur.2007.12.018|
|Appare nelle tipologie:||01 - Articolo su periodico|