Cardiac valve surgery in the octogenarian

Heart

Volumn 83, Issue 1, 2000, Pages 116-121

  Prêtre, René ^a   Turina, Marko I ^a  

^a UNIVERSITY HOSPITAL ZURICH   (Switzerland)

Author keywords

[No Author keywords available]

Indexed keywords

AORTA VALVE DISEASE; ARTICLE; ELDERLY CARE; GERIATRIC PATIENT; HEALTH CARE QUALITY; HEART VALVE SURGERY; HUMAN; MAJOR CLINICAL STUDY; MEDICAL DECISION MAKING; MITRAL VALVE DISEASE; MORTALITY; PREOPERATIVE CARE; PREVALENCE; PRIORITY JOURNAL; SURGICAL RISK;

AGED; ANGIOPLASTY, TRANSLUMINAL, PERCUTANEOUS CORONARY; AORTIC VALVE INSUFFICIENCY; AORTIC VALVE STENOSIS; COMORBIDITY; HEART VALVE DISEASES; HEART VALVE PROSTHESIS IMPLANTATION; HUMANS; MITRAL VALVE INSUFFICIENCY; MITRAL VALVE STENOSIS; SURVIVAL RATE;

EID: 0034027079     PISSN: 13556037     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (16)

1. 1. Roques F, Gabrielle F, Michel P, et al. Quality of care in adult heart surgery: proposal for a self-assessment approach based on a French multicenter study. Eur J Cardiothorac Surg 1995;9:433-9. This prospective multicentred study validated the French scoring system for assessment of the operative risk in open heart surgery. The French score showed a better predictive accuracy in operative mortality than the much used Parsonnet score. Area under the relative operative characteristic curve (so called ROC curve) was 0.75 for the French and 0.65 for the Parsonnet score.
2. 2. Katz ES, Tunick PA, Rusinek H, et al. Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol 1992;20:70-7. This study showed that direct palpation of the aorta is unreliable in detecting patients at risk for plaque material embolisation during manipulation of the aorta. Transesophageal echocardiography more reliably detects dangerous, friable atheromatous plaques.
3. 3. Culliford AT, Galloway AC, Colvin SB, et al. Aortic valve replacement for aortic stenosis in persons aged 80 years and over. Am J Cardiol 1991;67:1256-60. This retrospective study reports excellent early and late results in 71 octogenarian patients after aortic valve replacement alone or with associated coronary artery bypass surgery.
4. 4. Freeman WK, Schaff HV, O'Brien PC, et al. Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol 1991;18:29-35. General overview of the results of open heart surgery in 191 octogenarian patients. Follow up extended to five years (mean 22 months). The authors state that cardiac surgery improved longevity in all subsets of patients surviving operation.
5. 5. Akins CW, Daggett WM, Vlahakes GJ, et al. Cardiac operations in patients 80 years old and older. Ann Thorac Surg 1997;64:606-14. Excellent retrospective study on 600 consecutive octogenarian patients undergoing valve or coronary artery surgery, or both. Overall mortality was 8% and overall postoperative stroke rate 7%.
6. 6. Elayda MA, Hall RJ, Reul RM, et al. Aortic valve replacement in patients 80 years and older. Operative risks and long-term results. Circulation 1993;88(part 2):11-16. One of the largest series of aortic valve replacement in octogenarian patients (171 patients). Mortality for isolated AVR was 5.2%, for AVR and CABG 24%, and for AVR and MVR 35%. The authors recommend a mechanical prosthesis for annuli ≤ 23 mm because of superior haemodynamic characteristics compared to bioprosthesis. Many authors have achieved better results with combined procedures.
7. 7. Gehlot A, Mullany CJ, Ilstrup D, et al. Aortic valve replacement in patients aged eighty years and older: early and long-term results. J Thorac Cardiovasc Surg 1996;111:1026-36. Largest series (322 patients), spanning 20 years of aortic valve replacement in octogenarians. Risk factors for early death included female sex, creatinine concentration > 150 mg/l, concomitant CABG, reduced left ventricular ejection fraction < 35%, and chronic obstructive pulmonary disease. Extensive analysis of long term survival. Overall, survival (including early mortality) was 83% and 60% at one and five years, respectively.
8. 8. Shapira OM, Kelleher RM, Zelingher J, et al. Prognosis and quality of life after valve surgery in patients older than 75 years. Chest 1997;112:885-94. One of the few studies that analyses quality of life after surgery. Most patients reported that their health status had improved and rated it to be between good and excellent. Postoperative stroke (4.8% of patients) had a devastating effect on the quality of life.
9. 9. O'Keefe JH Jr, Vlietstra RE, Bailey KR, et al. Natural history of candidates for balloon aortic valvoplasty. Mayo Clin Proc 1987;62:986-91.
10. 10. Bernard Y, Etievent J, Mourand JL, et al. Long-term results of percutaneous aortic valvoplasty compared with aortic valve replacement in patients more than 75 years old. J Am Coll Cardiol 1992;20:796-801. The long term results of aortic balloon valvoplasty turned out to be disappointing, with a significant early mortality (6.5%), an additional 52% mortality rate at three years, and a need to operate on 35% of surviving patients within 35 months. This report sharply contrasts with that of another group in France, which claimed a 0% postprocedural mortality and a 73% survival rate at one year (Eltchaninoff et al. Eur Heart J 1995;16:1079-84).Other reports are in keeping with Bernard's experience.
11. 10. Bernard Y, Etievent J, Mourand JL, et al. Long-termresults of percutaneous aortic valvoplasty compared withaortic valve replacement in patients more than 75 years old.J Am Coll Cardiol 1992;20:796-801. The long term results of aortic balloon valvoplasty turnedout to be disappointing, with a significant early mortality (6.5%), an additional 52% mortality rate at three years,and a need to operate on 35% of surviving patients within35 months. This report sharply contrasts with that ofanother group in France, which claimed a 0%postprocedural mortality and a 73% survival rate at oneyear (Eltchaninoff et al. Eur Heart J 1995;16:1079-84). Other reports are in keeping with Bernard's experience.
12. 11. Otto CM, Mickel MC, Kennedy JW, et al. Three-year outcome after balloon aortic valvoplasty. Insights into prognosis of valvular aortic stenosis. Circulation 1994;89:642-50.
13. 12. Bolling SF, Deeb GM, Bach DS. Mitral valve reconstruction in elderly, ischemic patients. Chest 1996;109:35-40. This group showed that mitral valve repair was an excellent treatment in elderly patients with ischaemic mitral regurgitation. Unfortunately, very few operative data have been included (methods of repair, time of myocardial ischemia have not been reported). The consequences of the ventricular-annular distortion following mitral valve replacement are well explained.
14. 13. Asimakopoulos G, Edwards MB, Brannan J, et al. Survival and cause of death after mitral valve replacement in patients aged 80 years and over: collective results from the UK heart valve registry. Eur J Cardiothorac Surg 1997;11:922-8. The UK heart valve registry reported an early mortality after mitral valve replacement in 86 octogenarians of 10% and subsequent survival rates at one, three, and five years of 80%, 64%, and 41 %, respectively. The registry has the advantage of presenting the average results for the country, while the literature favours publication of reports with good results. It does not, however, inform on the prevalence of other risk factors such as associated coronary artery disease, which could explain the disappointing midterm result.
15. 14. Davis EA, Gardner TJ, Gillinov AM, et al. Valvular disease in the elderly: influence on surgical results. Ann Thorac Surg 1993;55:333-7. Concomitant CABG increased early mortality from 3.3% (AVR alone) to 7.2% (AVR and CABG) and raises the question of how aggressively revascularisation should be pursued. A more advanced myocardial dysfunction in patients requiring concomitant CABG was probably responsible for the increased mortality. Limiting revascularisation to the major coronary trunks could be the answer to this puzzling question.
16. 15. Iung B, Cormier B, Farah B, et al. Percutaneous mitral commissurotomy in the elderly. Eur Heart J 1995;16:1092-9. Improvement of valve function was only moderate, and subsequent functional deterioration frequent after percutaneous mitral commissurotomy. This palliative approach should not be enthusiastically presented, even to elderly patients, when the surgical risk lies within acceptable limits.