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Eur J Cardiothorac Surg. 2014 Feb;45(2):335-40. doi: 10.1093/ejcts/ezt242. Epub 2013 May 9.

Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients.

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1
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.

Abstract

OBJECTIVES:

Although the number of elderly patients undergoing combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is increasing, the early and mid-term outcomes of this combined procedure remain to be determined. We sought to elucidate the early and mid-term outcomes of elderly (≥75 years) vs non-elderly (<75 years) patients who underwent combined AVR and CABG.

METHODS:

Between September 2004 and September 2011, 259 patients underwent combined AVR and CABG at our institute, including 155 elderly patients (59.8%; Elderly group) with a mean age of 79.8 ± 3.6 years and 104 non-elderly patients (40.2%; Non-elderly group) with a mean age of 67.3±5.8 years. Early and mid-term outcomes were compared, and multivariate analyses were performed to determine the risk factors for morbidity and mortality. The mean follow-up times were 33.1±21.7 and 37.4±22.2 months in the Elderly and Non-elderly groups, respectively.

RESULTS:

The mean number of anastomoses and the frequency of use of the internal thoracic artery were similar between the two groups. The use of a mechanical valve was less frequent in the Elderly group than in the Non-elderly group (11.6 vs 60.6%, P<0.001). The Elderly and Non-elderly groups had similar rates of operative death (1.9 vs 1.0%, P=0.651), early stroke (2.6 vs 1.0%, P=0.651), 5-year overall survival (83.1±4.8 vs 87.2±5.2%, P=0.358), 5-year freedom from cardiac death (92.3±2.7 vs 94.8±3.4%, P=0.570) and 5-year freedom from stroke (94.0±2.6 vs 99.0±1.0%, P=0.097). Cox proportional hazards analyses identified diabetes, creatinine level and EuroSCORE II, but not age, as independent predictors of overall mortality rate.

CONCLUSIONS:

Early and mid-term outcomes of combined AVR and CABG were similar between elderly and non-elderly patients. Older age was not a risk factor for mortality in patients undergoing combined AVR plus CABG, and this procedure should be recommended in properly selected elderly patients.

KEYWORDS:

Aortic valve replacement; Coronary artery bypass grafting; Elderly

PMID:
23660551
DOI:
10.1093/ejcts/ezt242
[Indexed for MEDLINE]
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