Aortic valve replacement in elderly patients

Influence of concomitant coronary grafting on late survival

Guo Wei He, Gary L. Grunkemeier, Albert Starr

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background. Aortic valve replacement (AVR) has been an accepted therapy for elderly patients (>70 years) with aortic valve disease. This study was designed to investigate the determinants of survival after the implantation of aortic valve prostheses, with emphasis on the effect of concomitant coronary artery bypass grafting on survival. Methods. From November 1964 to July 1994, 963 elderly patients underwent isolated AVR. Long-term survival was investigated in 877 patients (70 to 94 years) who survived operation, with 92% follow-up completeness (mean ± standard deviation, 4.5 ± 3.9 years; maximum, 20.1 years; total, 3,920.2 patient-years), by univariate and multivariate analyses. Results. Actuarial survival was 38.1% ± 2.8% at 10 years, 17.8% ± 3.0% at 15 years, and 9.0% ± 3.1% at 20 years. Eight variables (age, sex, body surface area [less or greater than 1.7 m2], period of operation, type of prosthesis, size of prosthesis, re-replacement, and concomitant coronary artery bypass grafting) were investigated with regard to long-term survival by the Kaplan-Meier method. Age, sex, and body surface area were significant. Multivariate analysis revealed that older age (p = 0.0005) and male sex (p = 0.0001) were independent variables that determined long-term survival. Conclusions. Elderly patients may have satisfactory long- term results after AVR. Age and sex are independent determinants. Other factors (such as concomitant coronary artery bypass grafting and type of prosthesis) did not independently influence long-term survival. Coronary revascularization in elderly patients with coronary disease undergoing AVR may lead to a long-term survival similar to that in patients without coronary disease undergoing AVR.

Original languageEnglish (US)
Pages (from-to)1746-1751
Number of pages6
JournalAnnals of Thoracic Surgery
Volume61
Issue number6
DOIs
StatePublished - Jun 1996
Externally publishedYes

Fingerprint

Aortic Valve
Survival
Prostheses and Implants
Coronary Artery Bypass
Body Surface Area
Coronary Disease
Multivariate Analysis
Aortic Diseases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Aortic valve replacement in elderly patients : Influence of concomitant coronary grafting on late survival. / He, Guo Wei; Grunkemeier, Gary L.; Starr, Albert.

In: Annals of Thoracic Surgery, Vol. 61, No. 6, 06.1996, p. 1746-1751.

Research output: Contribution to journalArticle

He, Guo Wei ; Grunkemeier, Gary L. ; Starr, Albert. / Aortic valve replacement in elderly patients : Influence of concomitant coronary grafting on late survival. In: Annals of Thoracic Surgery. 1996 ; Vol. 61, No. 6. pp. 1746-1751.
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abstract = "Background. Aortic valve replacement (AVR) has been an accepted therapy for elderly patients (>70 years) with aortic valve disease. This study was designed to investigate the determinants of survival after the implantation of aortic valve prostheses, with emphasis on the effect of concomitant coronary artery bypass grafting on survival. Methods. From November 1964 to July 1994, 963 elderly patients underwent isolated AVR. Long-term survival was investigated in 877 patients (70 to 94 years) who survived operation, with 92{\%} follow-up completeness (mean ± standard deviation, 4.5 ± 3.9 years; maximum, 20.1 years; total, 3,920.2 patient-years), by univariate and multivariate analyses. Results. Actuarial survival was 38.1{\%} ± 2.8{\%} at 10 years, 17.8{\%} ± 3.0{\%} at 15 years, and 9.0{\%} ± 3.1{\%} at 20 years. Eight variables (age, sex, body surface area [less or greater than 1.7 m2], period of operation, type of prosthesis, size of prosthesis, re-replacement, and concomitant coronary artery bypass grafting) were investigated with regard to long-term survival by the Kaplan-Meier method. Age, sex, and body surface area were significant. Multivariate analysis revealed that older age (p = 0.0005) and male sex (p = 0.0001) were independent variables that determined long-term survival. Conclusions. Elderly patients may have satisfactory long- term results after AVR. Age and sex are independent determinants. Other factors (such as concomitant coronary artery bypass grafting and type of prosthesis) did not independently influence long-term survival. Coronary revascularization in elderly patients with coronary disease undergoing AVR may lead to a long-term survival similar to that in patients without coronary disease undergoing AVR.",
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N2 - Background. Aortic valve replacement (AVR) has been an accepted therapy for elderly patients (>70 years) with aortic valve disease. This study was designed to investigate the determinants of survival after the implantation of aortic valve prostheses, with emphasis on the effect of concomitant coronary artery bypass grafting on survival. Methods. From November 1964 to July 1994, 963 elderly patients underwent isolated AVR. Long-term survival was investigated in 877 patients (70 to 94 years) who survived operation, with 92% follow-up completeness (mean ± standard deviation, 4.5 ± 3.9 years; maximum, 20.1 years; total, 3,920.2 patient-years), by univariate and multivariate analyses. Results. Actuarial survival was 38.1% ± 2.8% at 10 years, 17.8% ± 3.0% at 15 years, and 9.0% ± 3.1% at 20 years. Eight variables (age, sex, body surface area [less or greater than 1.7 m2], period of operation, type of prosthesis, size of prosthesis, re-replacement, and concomitant coronary artery bypass grafting) were investigated with regard to long-term survival by the Kaplan-Meier method. Age, sex, and body surface area were significant. Multivariate analysis revealed that older age (p = 0.0005) and male sex (p = 0.0001) were independent variables that determined long-term survival. Conclusions. Elderly patients may have satisfactory long- term results after AVR. Age and sex are independent determinants. Other factors (such as concomitant coronary artery bypass grafting and type of prosthesis) did not independently influence long-term survival. Coronary revascularization in elderly patients with coronary disease undergoing AVR may lead to a long-term survival similar to that in patients without coronary disease undergoing AVR.

AB - Background. Aortic valve replacement (AVR) has been an accepted therapy for elderly patients (>70 years) with aortic valve disease. This study was designed to investigate the determinants of survival after the implantation of aortic valve prostheses, with emphasis on the effect of concomitant coronary artery bypass grafting on survival. Methods. From November 1964 to July 1994, 963 elderly patients underwent isolated AVR. Long-term survival was investigated in 877 patients (70 to 94 years) who survived operation, with 92% follow-up completeness (mean ± standard deviation, 4.5 ± 3.9 years; maximum, 20.1 years; total, 3,920.2 patient-years), by univariate and multivariate analyses. Results. Actuarial survival was 38.1% ± 2.8% at 10 years, 17.8% ± 3.0% at 15 years, and 9.0% ± 3.1% at 20 years. Eight variables (age, sex, body surface area [less or greater than 1.7 m2], period of operation, type of prosthesis, size of prosthesis, re-replacement, and concomitant coronary artery bypass grafting) were investigated with regard to long-term survival by the Kaplan-Meier method. Age, sex, and body surface area were significant. Multivariate analysis revealed that older age (p = 0.0005) and male sex (p = 0.0001) were independent variables that determined long-term survival. Conclusions. Elderly patients may have satisfactory long- term results after AVR. Age and sex are independent determinants. Other factors (such as concomitant coronary artery bypass grafting and type of prosthesis) did not independently influence long-term survival. Coronary revascularization in elderly patients with coronary disease undergoing AVR may lead to a long-term survival similar to that in patients without coronary disease undergoing AVR.

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