Aortic Valve Replacement With or Without Coronary Artery Bypass Graft Surgery: The Risk of Surgery in Patients ≥80 Years Old

Objective: The purpose of this study was to evaluate the outcomes for elderly (>= 80 years) patients undergoing aortic valve replacement (AVR) with or without coronary artery bypass graft surgery (AVR/CABG). The authors hypothesized that the mortalities of AVR and AVR/CABG are lower than that predicted by published risk scores. Design: A retrospective analysis of data from a single-hospital database. Setting: Single tertiary care, private practice. Participants: Consecutive patients undergoing AVR or AVR/CABG. Measurements: Two hundred sixty-one elderly (>= 80 years) patients undergoing isolated AVR (145) or AVR/CABG (116) were evaluated. The majority (94.6%) underwent AVR for aortic valve stenosis. Outcomes were recorded and compared between the 2 surgical procedures with predicted mortalities based on published risk assessment scoring systems. Results: The overall short-term mortality for the elderly group was 6.1% (AVR 5.5% and AVR/CABG 6.9%). The median long-term survival was 6.8 years. There were no significant differences in either morbidity or mortality between the AVR and AVR/CABG groups. Although predicted mortalities were similar for each surgical procedure, they overestimated observed outcome by up to 4-fold. Conclusions: Short- and long-term mortality was low for this group of elderly patients undergoing AVR or AVR/CABG and not significantly different between the 2 surgical groups. Predicted outcomes were worse than that observed, consistent with the hypothesis, and supportive of a more aggressive surgical treatment for aortic valve disease in the elderly patient. (C) 2010 Elsevier Inc. All rights reserved.