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Aortic valve replacement with or without concomitant coronary artery bypass grafting in very elderly patients aged 85 years and older

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Abstract

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.

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Acknowledgements

The authors would like to thank Hiroyuki Tanaka for his technical assistance.

Funding

This work was not supported by any Grants.

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Authors and Affiliations

  1. Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan

    Kazuyoshi Takagi, Koichi Arinaga, Tohru Takaseya, Hiroyuki Otsuka, Takahiro Shojima, Yusuke Shintani, Yasuyuki Zaima, Kosuke Saku, Atsunobu Oryoji & Shinichi Hiromatsu

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  1. Kazuyoshi Takagi
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  2. Koichi Arinaga
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kazuyoshi Takagi, Koichi Arinaga, Tohru Takaseya, Hiroyuki Otsuka, Takahiro Shojima, Yusuke Shintani, Yasuyuki Zaima, Kosuke Saku, Atsunobu Oryoji and Shinichi Hiromatsu. The first draft of the manuscript was written by Kazuyoshi Takagi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kazuyoshi Takagi.

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Ethical approval was waived by the local Ethics Committee of Kurume University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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We obtained informed consents from all patients preoperatively to analyze their clinical data for retrospective studies.

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Takagi, K., Arinaga, K., Takaseya, T. et al. Aortic valve replacement with or without concomitant coronary artery bypass grafting in very elderly patients aged 85 years and older. Heart Vessels 35, 1409–1418 (2020). https://doi.org/10.1007/s00380-020-01620-1

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