Aortic Valve Replacement in Octogenarians

Is Biologic Valve the Unique Solution?

Carlo de Vincentiis, Alessia B. Kunkl, Santi Trimarchi, Piervincenzo Gagliardotto, Alessandro Frigiola, Lorenzo Menicanti, Marisa Di Donato

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Abstract

Background: This study analyzed morbidity, mortality, and quality of life after aortic valve replacement with mechanical and biologic prostheses in octogenarian patients. Methods: A retrospective analysis was performed in 345 consecutive patients, mean age of 82 ± 2 years (range, 80 to 92), who had aortic valve replacement from May 1991 to April 2005. A bioprosthesis (group I) was used in 200 patients (58%), and 145 (42%) received a mechanical prosthesis (group II). Associated cardiac procedures were done in 211 patients (61%), of which 71% were coronary artery bypass grafting. Patients had symptomatic aortic stenosis (84.3%) or associated aortic insufficiency; 88% were in New York Heart Association (NYHA) class III or IV. The mean preoperative aortic valve gradient was 62 ± 16 mm Hg (range, 25 to 122 mm Hg). The mean left ventricular ejection fraction was good (0.52 ± 0.12); 30 patients (8.7%) had an ejection fraction of less than 0.30. Results: The in-hospital mortality rate was 7.5% (26 patients); 17 (8.5%) in group I and 9 (6.2%) in group II (p = 0.536) Significant predictors of operative mortality were preoperative renal insufficiency (blood creatinine > 2.00 mg/mL) and need for urgent operation. Mean follow-up, complete at 100%, was 40 ± 33 months (range, 1 to 176 months). Long-term follow-up, using Kaplan-Meier analysis, showed an overall survival of 61% at 5 years and 21% at 10 years; survival by type of prosthesis was significantly higher with mechanical prostheses (log-rank p = 0.03). Freedom from cerebrovascular events (thromboembolic/hemorrhagic) at 5 and 10 years was 89% and 62% in the mechanical group and 92% and 77% in the biologic group (p = 0.76). Postoperative NYHA functional class was I or II in 96% of patients. Quality-of-life scores were excellent considering the age of the patients. No differences were found between the two groups. Conclusions: Surgical treatment for symptomatic aortic stenosis in octogenarians has an acceptable operative risk with excellent long-term results and good quality of life. In this cohort, survival rate is slightly but significantly higher with mechanical prostheses.

Original languageEnglish
Pages (from-to)1296-1301
Number of pages6
JournalAnnals of Thoracic Surgery
Volume85
Issue number4
DOIs
Publication statusPublished - Apr 2008

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Aortic Valve
Prostheses and Implants
Aortic Valve Stenosis
Quality of Life
Mortality
Prosthesis Failure
Bioprosthesis
Kaplan-Meier Estimate
Hospital Mortality
Coronary Artery Bypass
Stroke Volume
Renal Insufficiency
Creatinine
Survival Rate
Morbidity
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Aortic Valve Replacement in Octogenarians : Is Biologic Valve the Unique Solution? / de Vincentiis, Carlo; Kunkl, Alessia B.; Trimarchi, Santi; Gagliardotto, Piervincenzo; Frigiola, Alessandro; Menicanti, Lorenzo; Di Donato, Marisa.

In: Annals of Thoracic Surgery, Vol. 85, No. 4, 04.2008, p. 1296-1301.

Research output: Contribution to journalArticle

de Vincentiis, Carlo ; Kunkl, Alessia B. ; Trimarchi, Santi ; Gagliardotto, Piervincenzo ; Frigiola, Alessandro ; Menicanti, Lorenzo ; Di Donato, Marisa. / Aortic Valve Replacement in Octogenarians : Is Biologic Valve the Unique Solution?. In: Annals of Thoracic Surgery. 2008 ; Vol. 85, No. 4. pp. 1296-1301.
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title = "Aortic Valve Replacement in Octogenarians: Is Biologic Valve the Unique Solution?",
abstract = "Background: This study analyzed morbidity, mortality, and quality of life after aortic valve replacement with mechanical and biologic prostheses in octogenarian patients. Methods: A retrospective analysis was performed in 345 consecutive patients, mean age of 82 ± 2 years (range, 80 to 92), who had aortic valve replacement from May 1991 to April 2005. A bioprosthesis (group I) was used in 200 patients (58{\%}), and 145 (42{\%}) received a mechanical prosthesis (group II). Associated cardiac procedures were done in 211 patients (61{\%}), of which 71{\%} were coronary artery bypass grafting. Patients had symptomatic aortic stenosis (84.3{\%}) or associated aortic insufficiency; 88{\%} were in New York Heart Association (NYHA) class III or IV. The mean preoperative aortic valve gradient was 62 ± 16 mm Hg (range, 25 to 122 mm Hg). The mean left ventricular ejection fraction was good (0.52 ± 0.12); 30 patients (8.7{\%}) had an ejection fraction of less than 0.30. Results: The in-hospital mortality rate was 7.5{\%} (26 patients); 17 (8.5{\%}) in group I and 9 (6.2{\%}) in group II (p = 0.536) Significant predictors of operative mortality were preoperative renal insufficiency (blood creatinine > 2.00 mg/mL) and need for urgent operation. Mean follow-up, complete at 100{\%}, was 40 ± 33 months (range, 1 to 176 months). Long-term follow-up, using Kaplan-Meier analysis, showed an overall survival of 61{\%} at 5 years and 21{\%} at 10 years; survival by type of prosthesis was significantly higher with mechanical prostheses (log-rank p = 0.03). Freedom from cerebrovascular events (thromboembolic/hemorrhagic) at 5 and 10 years was 89{\%} and 62{\%} in the mechanical group and 92{\%} and 77{\%} in the biologic group (p = 0.76). Postoperative NYHA functional class was I or II in 96{\%} of patients. Quality-of-life scores were excellent considering the age of the patients. No differences were found between the two groups. Conclusions: Surgical treatment for symptomatic aortic stenosis in octogenarians has an acceptable operative risk with excellent long-term results and good quality of life. In this cohort, survival rate is slightly but significantly higher with mechanical prostheses.",
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AU - Kunkl, Alessia B.

AU - Trimarchi, Santi

AU - Gagliardotto, Piervincenzo

AU - Frigiola, Alessandro

AU - Menicanti, Lorenzo

AU - Di Donato, Marisa

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N2 - Background: This study analyzed morbidity, mortality, and quality of life after aortic valve replacement with mechanical and biologic prostheses in octogenarian patients. Methods: A retrospective analysis was performed in 345 consecutive patients, mean age of 82 ± 2 years (range, 80 to 92), who had aortic valve replacement from May 1991 to April 2005. A bioprosthesis (group I) was used in 200 patients (58%), and 145 (42%) received a mechanical prosthesis (group II). Associated cardiac procedures were done in 211 patients (61%), of which 71% were coronary artery bypass grafting. Patients had symptomatic aortic stenosis (84.3%) or associated aortic insufficiency; 88% were in New York Heart Association (NYHA) class III or IV. The mean preoperative aortic valve gradient was 62 ± 16 mm Hg (range, 25 to 122 mm Hg). The mean left ventricular ejection fraction was good (0.52 ± 0.12); 30 patients (8.7%) had an ejection fraction of less than 0.30. Results: The in-hospital mortality rate was 7.5% (26 patients); 17 (8.5%) in group I and 9 (6.2%) in group II (p = 0.536) Significant predictors of operative mortality were preoperative renal insufficiency (blood creatinine > 2.00 mg/mL) and need for urgent operation. Mean follow-up, complete at 100%, was 40 ± 33 months (range, 1 to 176 months). Long-term follow-up, using Kaplan-Meier analysis, showed an overall survival of 61% at 5 years and 21% at 10 years; survival by type of prosthesis was significantly higher with mechanical prostheses (log-rank p = 0.03). Freedom from cerebrovascular events (thromboembolic/hemorrhagic) at 5 and 10 years was 89% and 62% in the mechanical group and 92% and 77% in the biologic group (p = 0.76). Postoperative NYHA functional class was I or II in 96% of patients. Quality-of-life scores were excellent considering the age of the patients. No differences were found between the two groups. Conclusions: Surgical treatment for symptomatic aortic stenosis in octogenarians has an acceptable operative risk with excellent long-term results and good quality of life. In this cohort, survival rate is slightly but significantly higher with mechanical prostheses.

AB - Background: This study analyzed morbidity, mortality, and quality of life after aortic valve replacement with mechanical and biologic prostheses in octogenarian patients. Methods: A retrospective analysis was performed in 345 consecutive patients, mean age of 82 ± 2 years (range, 80 to 92), who had aortic valve replacement from May 1991 to April 2005. A bioprosthesis (group I) was used in 200 patients (58%), and 145 (42%) received a mechanical prosthesis (group II). Associated cardiac procedures were done in 211 patients (61%), of which 71% were coronary artery bypass grafting. Patients had symptomatic aortic stenosis (84.3%) or associated aortic insufficiency; 88% were in New York Heart Association (NYHA) class III or IV. The mean preoperative aortic valve gradient was 62 ± 16 mm Hg (range, 25 to 122 mm Hg). The mean left ventricular ejection fraction was good (0.52 ± 0.12); 30 patients (8.7%) had an ejection fraction of less than 0.30. Results: The in-hospital mortality rate was 7.5% (26 patients); 17 (8.5%) in group I and 9 (6.2%) in group II (p = 0.536) Significant predictors of operative mortality were preoperative renal insufficiency (blood creatinine > 2.00 mg/mL) and need for urgent operation. Mean follow-up, complete at 100%, was 40 ± 33 months (range, 1 to 176 months). Long-term follow-up, using Kaplan-Meier analysis, showed an overall survival of 61% at 5 years and 21% at 10 years; survival by type of prosthesis was significantly higher with mechanical prostheses (log-rank p = 0.03). Freedom from cerebrovascular events (thromboembolic/hemorrhagic) at 5 and 10 years was 89% and 62% in the mechanical group and 92% and 77% in the biologic group (p = 0.76). Postoperative NYHA functional class was I or II in 96% of patients. Quality-of-life scores were excellent considering the age of the patients. No differences were found between the two groups. Conclusions: Surgical treatment for symptomatic aortic stenosis in octogenarians has an acceptable operative risk with excellent long-term results and good quality of life. In this cohort, survival rate is slightly but significantly higher with mechanical prostheses.

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