Surgical Aortic Valve Replacement in Very Elderly Patients Aged 80 Years and Over: Evaluation of Early Clinical Outcomes - 25/02/14
, Manu N. Mathur, FRACS b, Peter W. Brady, FRACS b, David Marshman, FRACS b, Russell J. Brereton, FRACS b, Donald E. Ross, FRACS b, Ravinay Bhindi, FRACP, PhD a, Peter S. Hansen, FRACP, PhD aRésumé |
Background |
An increasing number of very elderly patients aged ≥80 years will require aortic valve replacement (AVR) for severe aortic stenosis (AS). Many are classified as high-risk surgical candidates. Transcatheter aortic valve implantation (TAVI) has been proposed as an alternative to surgical AVR (SAVR) for high-risk patients. We evaluated early clinical outcomes of very elderly patients undergoing SAVR to optimise TAVI candidate selection.
Methods |
We conducted a retrospective case review of 132 consecutive patients aged ≥80 years undergoing isolated SAVR (49 patients) or combined SAVR/CABG (83 patients) during February 2002–January 2010 at a single tertiary referral hospital. Risk for cardiac surgery was calculated using the logistic EuroSCORE (ESlog). Mortality and morbidity data were collected for the 30-day postoperative period.
Results |
Thirty-day mortality rate was 8.3% for patients undergoing SAVR (6.1% for isolated SAVR and 9.6% for SAVR/CABG). Permanent stroke occurred in 3.8% and renal insufficiency in 7.6% of the cohort. Thirty-five percent of patients had left ventricular ejection fraction <50%, 67% had advanced symptoms (NYHA class III or IV), and 42% of patients were stratified as high-risk (ESlog≥20%).
Conclusions |
SAVR can be performed in very elderly patients with acceptable operative morbidity and mortality. The outcomes at our institution are comparable to contemporary SAVR and TAVI outcomes.
Le texte complet de cet article est disponible en PDF.Keywords : Aortic stenosis, Aortic valve replacement, Elderly, Octogenarians, Transcatheter aortic valve implantation
Plan
Vol 23 - N° 3
P. 242-248 - mars 2014 Retour au numéro
Article précédent
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