Ann Thorac Cardiovasc Surg 2015; 21: 247–253
Original Article
Online May 25, 2015 doi: 10.5761/atcs.oa.15-00067
Early and Long-Term Outcomes in Japanese Patients Aged 80 Years or Older Undergoing Conventional Aortic Valve Replacement Akira Sezai, MD, PhD, Shunji Osaka, MD, PhD, Hiroko Yaoita, MD,Yusuke Ishii, MD, Munehito Arimoto, MD, Hiroaki Hata, MD, PhD, and Motomi Shiono, MD, PhD
In this study, we investigated the early and long-term results of conventional aortic valve replacement (AVR) in very old patients. Methods: Seventy-five patients with aortic stenosis underwent conventional AVR for patients aged 80 years.We examined early death and major adverse cardiovascular and cerebrovascular event (MACCE). Results: The operative mortality was 0% for isolated AVR and 19.2% for concomitant surgery. The postoperative survival rate and MACCE free-rate were no significant differences between the isolated AVR and the concomitant surgery. Univariate analysis confirmed that cardiac dysfunction, severe chronic kidney disease (CKD), hemodialysis, + coronary artery bypass grafting, and norepinephrine use were risk factor of early death. Univariate analysis confirmed that severe CKD, BNP >1000 pg/ml, aortic cross clamping time (ACCT) >180 min, and non-use carperitide and multivariate analysis confirmed that ACCT >180 min, and non-use carperitide were risk factor of MACCE. Conclusions: This study showed that the results of conventional AVR in very old patients were not satisfactory. However, the results obtained with isolated AVR were favorable with no operative deaths. The present study demonstrated that preoperative cardiac function, preoperative renal function, and operative factors have an important impact on early mortality and MACCE. Key words: aortic valve replacement, elderly, octogenarians
Introduction Aging of the Japanese population has become the most rapid worldwide. In addition, the average life expectancy is longer in Japan than in the USA and Europe, so the number of elderly patients undergoing cardiac surgery is The Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan Received: February 27, 2015; Accepted: March 24, 2015 Corresponding author: Akira Sezai, MD, PhD. The Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan E-mail: [email protected] ©2015 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.
Ann Thorac Cardiovasc Surg Vol. 21, No. 3 (2015)
increasing.1–3) The criteria for performing cardiac surgery in elderly patients have not been defined, but we need to consider medical problems such as an increased rate of cerebral complications and dementia compared to younger patients as well as social aspects such as medical costs or nursing care. There is an increasing number of elderly patients with valvular aortic stenosis and conventional aortic valve replacement (AVR) is performed for most of them, but the results are inferior compared with those obtained in younger patients. Following the development of transcatheter aortic valve implantation (TAVI), efficacy in patients for whom conventional AVR is not indicated has been reported.4–6) However, there is insufficient data on the efficacy of TAVI in various subgroups of patients, such as Japanese women who tend to have a 247
Sezai A, et al.
Table 1 Patient’s characteristics Number Age (years) ≥85 years Gender (male: female) BSA (m2) Pre NYHA class I II III IV Aortic stenosis Aortic regurgitation Aortic stenosis and regurgitation Risk factors Diabetes mellitus Hypertension Dyslipidaemia Obesity Smoking COPD Cardiac dysfunction (EF
Original Article
Online May 25, 2015 doi: 10.5761/atcs.oa.15-00067
Early and Long-Term Outcomes in Japanese Patients Aged 80 Years or Older Undergoing Conventional Aortic Valve Replacement Akira Sezai, MD, PhD, Shunji Osaka, MD, PhD, Hiroko Yaoita, MD,Yusuke Ishii, MD, Munehito Arimoto, MD, Hiroaki Hata, MD, PhD, and Motomi Shiono, MD, PhD
In this study, we investigated the early and long-term results of conventional aortic valve replacement (AVR) in very old patients. Methods: Seventy-five patients with aortic stenosis underwent conventional AVR for patients aged 80 years.We examined early death and major adverse cardiovascular and cerebrovascular event (MACCE). Results: The operative mortality was 0% for isolated AVR and 19.2% for concomitant surgery. The postoperative survival rate and MACCE free-rate were no significant differences between the isolated AVR and the concomitant surgery. Univariate analysis confirmed that cardiac dysfunction, severe chronic kidney disease (CKD), hemodialysis, + coronary artery bypass grafting, and norepinephrine use were risk factor of early death. Univariate analysis confirmed that severe CKD, BNP >1000 pg/ml, aortic cross clamping time (ACCT) >180 min, and non-use carperitide and multivariate analysis confirmed that ACCT >180 min, and non-use carperitide were risk factor of MACCE. Conclusions: This study showed that the results of conventional AVR in very old patients were not satisfactory. However, the results obtained with isolated AVR were favorable with no operative deaths. The present study demonstrated that preoperative cardiac function, preoperative renal function, and operative factors have an important impact on early mortality and MACCE. Key words: aortic valve replacement, elderly, octogenarians
Introduction Aging of the Japanese population has become the most rapid worldwide. In addition, the average life expectancy is longer in Japan than in the USA and Europe, so the number of elderly patients undergoing cardiac surgery is The Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan Received: February 27, 2015; Accepted: March 24, 2015 Corresponding author: Akira Sezai, MD, PhD. The Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan E-mail: [email protected] ©2015 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.
Ann Thorac Cardiovasc Surg Vol. 21, No. 3 (2015)
increasing.1–3) The criteria for performing cardiac surgery in elderly patients have not been defined, but we need to consider medical problems such as an increased rate of cerebral complications and dementia compared to younger patients as well as social aspects such as medical costs or nursing care. There is an increasing number of elderly patients with valvular aortic stenosis and conventional aortic valve replacement (AVR) is performed for most of them, but the results are inferior compared with those obtained in younger patients. Following the development of transcatheter aortic valve implantation (TAVI), efficacy in patients for whom conventional AVR is not indicated has been reported.4–6) However, there is insufficient data on the efficacy of TAVI in various subgroups of patients, such as Japanese women who tend to have a 247
Sezai A, et al.
Table 1 Patient’s characteristics Number Age (years) ≥85 years Gender (male: female) BSA (m2) Pre NYHA class I II III IV Aortic stenosis Aortic regurgitation Aortic stenosis and regurgitation Risk factors Diabetes mellitus Hypertension Dyslipidaemia Obesity Smoking COPD Cardiac dysfunction (EF
