TY - JOUR
T1 - Long-term survival after aortic valve replacement among high-risk elderly patients in the United States
T2 - Insights from the society of thoracic surgeons adult cardiac surgery database, 1991 to 2007
AU - Brennan, J. Matthew
AU - Edwards, Fred H.
AU - Zhao, Yue
AU - O'Brien, Sean M.
AU - Douglas, Pamela S.
AU - Peterson, Eric D.
PY - 2012/9/25
Y1 - 2012/9/25
N2 - Background-: Surgical aortic valve replacement (AVR) remains the standard of care for the treatment of operable, symptomatic aortic valve disease; however, to date, there are limited national data on the contemporary long-term outcomes after AVR in older individuals. Methods and Results-: We examined long-term survival among 145 911 AVR patients ≥65 years of age undergoing AVR at 1026 centers with participation in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from 1991 to 2007. In-hospital complications and long-term survival were stratified by age, Society of Thoracic Surgeons perioperative risk of mortality, and several comorbidities. The median patient age was 76 years; 16% had chronic lung disease, 6% had preoperative renal failure, 38% had heart failure, and 12% had prior cardiac surgery. The median survival in patients 65 to 69, 70 to 79, and ≥80 years of age undergoing isolated AVR was 13, 9, and 6 years, respectively. For AVR plus coronary artery bypass graft procedures, median survival was 10, 8, and 6 years, respectively. Although only 5% of isolated AVR patients had a high Society of Thoracic Surgeons perioperative risk of mortality (≥10%), their median survival was 2.5 to 2.7 years. Severe lung disease and renal failure were each associated with a ≥50% reduction in median survival among all age groups compared with those who did not have these comorbidities, whereas left ventricular dysfunction and prior cardiac operation were associated with a 25% reduction in median survival. Conclusion-: Long-term survival after surgical AVR in the elderly is excellent, although patients with a high Society of Thoracic Surgeons perioperative risk of mortality and those with certain comorbidities carry a particularly poor long-term prognosis.
AB - Background-: Surgical aortic valve replacement (AVR) remains the standard of care for the treatment of operable, symptomatic aortic valve disease; however, to date, there are limited national data on the contemporary long-term outcomes after AVR in older individuals. Methods and Results-: We examined long-term survival among 145 911 AVR patients ≥65 years of age undergoing AVR at 1026 centers with participation in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from 1991 to 2007. In-hospital complications and long-term survival were stratified by age, Society of Thoracic Surgeons perioperative risk of mortality, and several comorbidities. The median patient age was 76 years; 16% had chronic lung disease, 6% had preoperative renal failure, 38% had heart failure, and 12% had prior cardiac surgery. The median survival in patients 65 to 69, 70 to 79, and ≥80 years of age undergoing isolated AVR was 13, 9, and 6 years, respectively. For AVR plus coronary artery bypass graft procedures, median survival was 10, 8, and 6 years, respectively. Although only 5% of isolated AVR patients had a high Society of Thoracic Surgeons perioperative risk of mortality (≥10%), their median survival was 2.5 to 2.7 years. Severe lung disease and renal failure were each associated with a ≥50% reduction in median survival among all age groups compared with those who did not have these comorbidities, whereas left ventricular dysfunction and prior cardiac operation were associated with a 25% reduction in median survival. Conclusion-: Long-term survival after surgical AVR in the elderly is excellent, although patients with a high Society of Thoracic Surgeons perioperative risk of mortality and those with certain comorbidities carry a particularly poor long-term prognosis.
KW - aged
KW - aortic valve
KW - outcome assessment
UR - http://www.scopus.com/inward/record.url?scp=84866703384&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84866703384&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.112.091371
DO - 10.1161/CIRCULATIONAHA.112.091371
M3 - Review article
C2 - 22907936
AN - SCOPUS:84866703384
SN - 0009-7322
VL - 126
SP - 1621
EP - 1629
JO - Circulation
JF - Circulation
IS - 13
ER -