How to approach aortic valve disease in the elderly : a 25-year retrospective study : cardiovascular topic

• Published in: Cardiovascular Journal Of Africa Vol. 25; no. 5; pp. 244 - 248
• Main Authors: Aydin, Ebuzer, Kirali, Mehmet Kaan, Ozen, Yucel, Yerlikhan, Ozge Altas, Sarikaya, Sabit, Tuzun, Behzat
• Format: Journal Article
• Language: English
• Published: Clinics Cardive Publishing 04.11.2014
• Subjects: Aortic valve replacement; Elderly; Mortality; Surgery
• ISSN: 1995-1892; 1680-0745
• DOI: 10.5830/CVJA-2014-051

Objective : In the last decade, the number of elderly patients suffering from aortic valve disease has significantly increased. This study aimed to identify possible factors that could affect surgical and long-term outcomes in the light of a literature review regarding the management of aortic valve disease in the elderly. Methods : Between January 1990 and December 2012, a total of 114 patients (64 males, 50 females; mean age 76.6 ± 3.6 years; range 70-87 years) with aortic valve replacement (AVR) alone, or combined with coronary artery bypass grafting (CABG) or mitral surgery in our hospital, were retrospectively analysed. Results : In-hospital mortality was seen in 19 patients. The major causes of in-hospital mortality were low-cardiac output syndrome in eight patients (42.1%), respiratory insufficiency or infection in six (31.5%), multi-organ failure in four (21%), and stroke in one patient (5.2%). The main postoperative complications included arrhythmia in 26 patients (22.8%), renal failure in 11 (9.6%), respiratory infection in nine (7.9%), and stroke in three patients (2.6%). The mean length of intensive care unit and hospital stays were 6.4 ± 4.3 and 18 ± 12.8 days, respectively. During follow up, late mortality was seen in 28 patients (29.4%). Possible risk factors for long-term mortality were type of prosthesis, EuroSCORE ≥ 15, postoperative pacemaker implantation, respiratory infection, and haemodialysis. Among 65 long-term survivors, their activity level was good in 53 (81.5%) and poor in two. Conclusions : Our study results demonstrated that an individually tailored approach including scheduled surgery increases short- and long-term outcomes of AVR in patients aged ≥ 70 years. In addition, shorter cardiopulmonary bypass time may be more beneficial in this high-risk patient population.