Aortic Valve Replacement With or Without Concurrent Coronary Artery Bypass Grafting in Octogenarians: Eight-Year Cohort Study

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• 作者：Tom Kai Ming Wang ; MBChB^a ; ^{TWang@adhb.govt.nz} ; David HM Choi ; MBChB^a ; Tharumenthiran Ramanathan ; FRACS^a ; Peter N Ruygrok ; FRACP^a ; ^b
• 关键词：Aortic valve replacement ; Coronary artery bypass grafting ; Cardiac surgery ; Geriatrics
• 刊名：Heart, Lung and Circulation
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：26
• 期：1
• 页码：82-87
• 全文大小：264 K
• 卷排序：26

文摘

With the introduction of transcatheter aortic valve implantation (TAVI), there is increasing interest in evaluating outcomes of aortic valve replacement (AVR) with or without (+/-) concurrent coronary artery bypass grafting (CABG) particularly in high-risk patients. We reviewed the characteristics and outcomes of octogenarians undergoing isolated AVR and AVR+CABG.MethodsAll patients 80 years of age or older undergoing AVR+/-CABG at Auckland City Hospital during 2005-2012 were included, and their characteristics and outcomes analysed.ResultsThere were 93 and 104 octogenarians respectively undergoing isolated AVR and AVR+CABG with mean follow-up of 4.4+/-2.2 years and 4.1+/-2.3 years. Significant differences in baseline and operative characteristics contributed to higher EuroSCORE II (5.9 vs 6.4%, P=0.016) and STS Score (4.9 vs 6.9%, P<0.001) for AVR+CABG patients. They also had a significantly higher rate of 30-day mortality (0.0% vs 6.7%, P=0.015) and prolonged ventilation>24 hours (10.7% vs 23.1%, P<0.001), but not composite morbidity (P=0.248) or stroke (P=0.709). Long-term survival was similar at one, three and five years; 94.6%, 82.6% and 73.0% for AVR and 91.3%, 86.1% and 67.6% for AVR+CABG. Independent predictors of 30-day mortality included reduced creatinine clearance and history of myocardial infarction.ConclusionAVR+CABG had significantly higher but acceptable 30-day mortality in octogenarians than AVR. We have identified prognostic factors important in the decision-making of treatment modality, where age alone should not preclude surgery.