Degenerative aortic stenosis is the most common structural heart valve disease affecting the aging population. Catheter-based heart valve interventions are less invasive and very useful for very elderly patients. However, we often consider open heart surgery for these patients because of anatomical reasons and co-existing cardiac diseases, i.e., severe coronary artery disease. We aimed to analyze the outcomes of very elderly patients aged ≥ 85 years undergoing aortic valve replacement (AVR) with or without coronary artery bypass grafting (CABG). Twenty-nine very elderly patients aged ≥ 85 years who underwent AVR with CABG (n = 11, Group AC) or isolated AVR (n = 18, Group A) were examined. The overall mean age of the patients was 87.2 ± 2.6 (range 85-94) years. The estimated operative mortality rate, calculated using the Japan score, EuroSCORE II, and STS risk score, was 5.72%-10.88% in Group AC and 5.63%-8.30% in Group A. Aortic cross-clamp time (126.5 ± 29.0 vs. 96.9 ± 29.2 min, p = 0.016) was significantly longer in Group AC than in Group A. Although the major morbidity rate was higher in Group AC than in Group A (36% vs. 6%, p = 0.0336), the length of intensive care unit stay and hospital stay was comparable between both groups. There was no 30-day and hospital mortality in both groups. Eleven patients died during follow-up (senility, 5; cerebrovascular events, 2; renal failure, 1; unknown, 3). There were no significant differences in survival rates during follow-up (log-rank p value = 0.1051). The 1-, 2-, 3-, 4- and 5-year survival rates were 91%, 80%, 69%, 69% and 69%, respectively, in Group AC and 94%, 94%, 94%, 94% and 88%, respectively, in Group A. In conclusion, AVR with or without CABG could be safely performed in carefully selected very elderly patients with acceptable early- and long-term results. AVR with CABG in very elderly patients aged ≥ 85 offers similar results to isolated AVR in terms of 30-day mortality, hospital mortality, and long-term survival.

中文翻译：

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年龄在85岁及以上的老年患者中，主动脉瓣置换术伴有或不伴有冠状动脉搭桥术。

变性主动脉瓣狭窄是影响人口老龄化的最常见的结构性心脏瓣膜疾病。基于导管的心脏瓣膜干预对老年患者的侵入性较小，非常有用。但是，由于解剖学原因和并存的心脏病（即严重的冠状动脉疾病），我们经常考虑对这些患者进行心脏直视手术。我们旨在分析年龄≥85岁的老年患者接受或不进行冠状动脉搭桥术（CABG）的主动脉瓣置换术（AVR）的结局。检查了年龄≥85岁的29名非常年长的患者，他们接受了CABG的AVR（n = 11，AC组）或孤立的AVR（n = 18，A组）。患者的总体平均年龄为87.2±2.6岁（范围85-94）。估算的手术死亡率是使用日本评分EuroSCORE II计算得出的，AC组的STS和STS风险评分为5.72％-10.88％，A组为5.63％-8.30％。AC组的主动脉交叉钳夹时间（126.5±29.0 vs. 96.9±29.2 min，p = 0.016）明显更长尽管AC组的主要发病率高于A组（36％比6％，p = 0.0336），但两组的重症监护病房住院时间和住院时间相当。两组均无30天和医院死亡率。11例患者在随访中死亡（衰老5例；脑血管事件2例；肾衰竭1例；未知3例）。随访期间生存率无显着差异（对数秩p值= 0.1051）。AC组的1年，2年，3年，4年和5年生存率分别为91％，80％，69％，69％和69％，94％，94％，94％，94％分别占A组的％和88％。总而言之，精心挑选的非常年老的患者可以安全地进行伴有或不伴有CABG的AVR，并具有可接受的早期和长期效果。在≥85岁的老年患者中，CABG的AVR在30天死亡率，住院死亡率和长期生存率方面与单独的AVR相似。