Key result
Combined AVR and CABG in elderly patients (≥75 years) yielded similar operative death (1.9% vs 1.0%, P=0.651) and 5-year overall survival (83.1% vs 87.2%, P=0.358) compared to non-elderly patients.
Why the study?
Does combined AVR and CABG have similar early and mid-term outcomes in elderly (≥75 years) compared to non-elderly (<75 years) patients?
Cohort (n=259)
No
Does combined AVR and CABG have similar early and mid-term outcomes in elderly (≥75 years) compared to non-elderly (<75 years) patients?
Combined AVR and CABG can be performed in properly selected elderly patients (≥75 years) with early and mid-term mortality and stroke outcomes comparable to those in younger patients.
Answers are grounded in this paper and cite their sources.
May support combined AVR+CABG in selected elderly patients; leaves open need for randomized confirmation.
OBJECTIVES: Although the number of elderly patients undergoing combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is increasing, the early and mid-term outcomes of this combined procedure remain to be determined. We sought to elucidate the early and mid-term outcomes of elderly (≥75 years) vs non-elderly (<75 years) patients who underwent combined AVR and CABG. METHODS: Between September 2004 and September 2011, 259 patients underwent combined AVR and CABG at our institute, including 155 elderly patients (59.8%; Elderly group) with a mean age of 79.8 ± 3.6 years and 104 non-elderly patients (40.2%; Non-elderly group) with a mean age of 67.3±5.8 years. Early and mid-term outcomes were compared, and multivariate analyses were performed to determine the risk factors for morbidity and mortality. The mean follow-up times were 33.1±21.7 and 37.4±22.2 months in the Elderly and Non-elderly groups, respectively. RESULTS: The mean number of anastomoses and the frequency of use of the internal thoracic artery were similar between the two groups. The use of a mechanical valve was less frequent in the Elderly group than in the Non-elderly group (11.6 vs 60.6%, P<0.001). The Elderly and Non-elderly groups had similar rates of operative death (1.9 vs 1.0%, P=0.651), early stroke (2.6 vs 1.0%, P=0.651), 5-year overall survival (83.1±4.8 vs 87.2±5.2%, P=0.358), 5-year freedom from cardiac death (92.3±2.7 vs 94.8±3.4%, P=0.570) and 5-year freedom from stroke (94.0±2.6 vs 99.0±1.0%, P=0.097). Cox proportional hazards analyses identified diabetes, creatinine level and EuroSCORE II, but not age, as independent predictors of overall mortality rate. CONCLUSIONS: Early and mid-term outcomes of combined AVR and CABG were similar between elderly and non-elderly patients. Older age was not a risk factor for mortality in patients undergoing combined AVR plus CABG, and this procedure should be recommended in properly selected elderly patients.
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Fukui et al. (2013) conducted a cohort in Aortic valve disease and coronary artery disease (n=259). Combined AVR and CABG in elderly patients (≥75 years) vs. Combined AVR and CABG in non-elderly patients (<75 years) was evaluated on Operative death (p=0.651). Combined AVR and CABG in elderly patients (≥75 years) yielded similar operative death (1.9% vs 1.0%, P=0.651) and 5-year overall survival (83.1% vs 87.2%, P=0.358) compared to non-elderly patients.
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