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January 1, 1991European Journal of Cardio-Thoracic Surgery

Aortic valve replacement in patients over 80 years of age: a comparative standard for balloon valvuloplasty

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Key result

Aortic valve replacement in octogenarians is linked to ~64% five-year survival.

  • n=88

Why the study?

Elderly patients with symptomatic aortic valvular malfunction have a grave prognosis and have not been seriously considered for active treatment such as valve surgery or balloon valvuloplasty.

Population

88 patients over 80 years with symptomatic aortic valvular malfunction

Comparison

Aortic valve replacement with or without concomitant coronary artery bypass grafting

Design

Prospective cohort study

Follow-up

Up to 5 years (185 patient-years)

Authors

MAM. AzariadesOnassis Cardiac Surgery CenterCFCindy L. FesslerHope Heart InstituteAAAftab AhmadBahauddin Zakariya University

Discussion

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Implication

May inform shared decision-making for AVR in selected octogenarians; leaves open need for randomized comparisons with TAVR.

Key Points

  • Evaluate operative outcomes and long-term survival in octogenarians undergoing aortic valve replacement to establish a comparative clinical benchmark for balloon valvuloplasty.
  • Prospective cohort study tracking 88 patients aged over 80 years who underwent aortic valve replacement between 1972 and 1989 across 185 patient-years of follow-up.
  • Assessed baseline clinical status (96% NYHA class III or IV; 81% aortic stenosis) and operative interventions (43% concomitant coronary artery bypass grafting; 76% tissue valves post-1982).
  • Overall operative mortality was 16%, with significantly higher risk associated with emergency surgery, isolated valve replacement, advanced preoperative NYHA functional class, and female sex.
  • Overall 5-year actuarial survival was 64(7)%, with higher survival observed for concomitant coronary bypass grafting versus isolated replacement (70[11]% vs 59[8]%) and for males versus females (73[9]% vs 55[9]%).
  • The 5-year event-free survival was 97(2)% for valve-related mortality and 93(5)% for valve re-replacement.

Study Design

Type

Cohort (n=88)

Structured PICO

P
Population
88 patients over 80 years of age with symptomatic aortic valvular malfunction undergoing aortic valve replacement, prospectively followed for a total of 185 patient-years.
E
Exposure
Aortic valve replacement (mechanical or tissue valves, with or without concomitant coronary artery bypass grafting)
O
Outcome
Operative mortality and 5-year actuarial survivalhard clinical

Aortic valve replacement in octogenarians provides acceptable 5-year survival and excellent freedom from valve-related death or re-replacement, establishing it as a viable standard of care.

Cite This Study

Azariades et al. (1991) conducted a cohort in Symptomatic aortic valvular malfunction (n=88). Aortic valve replacement was evaluated on 5-year actuarial survival. Aortic valve replacement in patients over 80 years of age was associated with an overall operative mortality of 16% and a 5-year actuarial survival of 64%.

synapsesocial.com/papers/6aa823ccf57d0898095749dbhttps://doi.org/10.1016/1010-7940(91)90055-o
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Also Consider

Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Balloon Aortic Valvuloplasty in 170 Consecutive Patients1988 · 234 citations
  2. 2Aortic Valve Selection in the Elderly Patient1988 · 59 citations
  3. 3A Tri-Institutional Comparison of Tissue and Mechanical Valves using a Patient-Oriented Definition of “Treatment Failure”1987 · 41 citations