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

作者：Wang Tom Kai Ming^*; Choi David H M; Ramanathan Tharumenthiran; Ruygrok Peter N

来源：Heart Lung and Circulation, 2017, 26(1): 82-87.

DOI：10.1016/j.hlc.2016.04.028

• Aortic valve replacement
• Coronary artery bypass grafting
• Cardiac surgery
• Geriatrics

background
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. Methods
All 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. Results
There 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. Conclusion
AVR+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.

• 出版日期2017-1