What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic valve disease requiring replacement (n=285). Intervention: Aortic valve replacement combined with CABG vs. Isolated aortic valve replacement. Primary outcome: 5-year survival (p=0.62).

What question did this study set out to answer?

To evaluate operative risk factors and compare early and long-term outcomes of isolated aortic valve replacement versus aortic valve replacement combined with coronary artery bypass grafting in octogenarians and nonagenarians.

February 16, 2012European Journal of Cardio-Thoracic SurgeryOpen Access

Aortic valve replacement with and without combined coronary bypass grafts in very elderly patients: early and long-term results

Q: What are the key findings of this study?

Aortic valve replacement combined with CABG in very elderly patients resulted in similar 5-year survival compared to isolated aortic valve replacement (75.6% vs 82.4%; P=0.62).

Q: What does this research mean for the field?

Aortic valve replacement combined with coronary artery bypass grafting yields similar early mortality and 5-year survival compared to isolated aortic valve replacement in octogenarians and nonagenarians. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

AVR plus CABG shows similar 5-year survival to isolated AVR in very elderly patients.

P=0.62
n=285

Why the study?

The number of very elderly patients undergoing aortic valve replacement with or without combined coronary bypass grafting is increasing, but operative risk factors and long-term outcomes remain to be evaluated.

Does combining CABG with aortic valve replacement affect hospital mortality and long-term survival compared to isolated aortic valve replacement in very elderly patients?

Population

285 very elderly patients (octogenarians and nonagenarians) undergoing aortic valve replacement

Comparison

Isolated aortic valve replacement vs aortic valve replacement combined with coronary artery bypass grafts

Design

Retrospective cohort study

Follow-up

Mean 49.03 ± 19 months

Authors

ADAndrea Dell’AmoreUniversity of Padua TAThiago Mendonça de AquinoInstituto Federal de Educação, Ciência e Tecnologia de Alagoas MPM. PagliaroIRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola

Discussion

Member takes

Implication

Supports feasibility of combined AVR+CABG in very elderly without apparent survival penalty; leaves open need for randomized confirmation.

Key Points

To evaluate operative risk factors and compare early and long-term outcomes of isolated aortic valve replacement versus aortic valve replacement combined with coronary artery bypass grafting in octogenarians and nonagenarians.
Retrospectively analyzed 285 patients aged 80 years and older who underwent aortic valve replacement over a 10-year period.
Divided patients into isolated aortic valve replacement (group A, n=188) and combined aortic valve replacement with coronary artery bypass grafting (group B, n=97).
Monitored patients over a mean follow-up of 49.03 ± 19 months to track in-hospital mortality, complications, and 1-, 3-, and 5-year survival rates.
Overall hospital mortality was 5.3% without a significant difference between groups, though low-output syndrome occurred significantly more often in group B (P = 0.0001).
Survival rates at one, three, and five years were 97.1 ± 1.8%, 92.2 ± 2.2%, and 82.4 ± 3.6% in group A versus 97.2 ± 2.0%, 88.4 ± 2.7%, and 75.6 ± 3.2% in group B (P = 0.62).
Urgency status, ejection fraction <35%, clamping duration, intra-aortic balloon pump usage, dialysis, prolonged ventilation, myocardial infarction, and re-thoracotomy independently predicted hospital mortality.

Study Design

Type

Cohort (n=285)

Structured PICO

Does combining CABG with aortic valve replacement affect hospital mortality and long-term survival compared to isolated aortic valve replacement in very elderly patients?

Population

285 octogenarians and nonagenarians undergoing isolated aortic valve replacement or AVR combined with CABG, followed for a mean of 49 months.

Exposure

Aortic valve replacement combined with coronary artery bypass grafts (CABG) (n=97)

Comparator

Isolated aortic valve replacement (n=188)

Outcome

Hospital mortality and long-term survival (at 1, 3, and 5 years)hard clinical

Main Result

Absolute Event Rate: 75.6% vs 82.4%

p-value: p=0.62

In very elderly patients, combining CABG with aortic valve replacement yields similar hospital mortality and long-term survival compared to isolated AVR, despite a higher incidence of postoperative low-output syndrome.

Cite This Study

Dell’Amore et al. (2012) conducted a cohort in Aortic valve disease requiring replacement (n=285). Aortic valve replacement combined with CABG vs. Isolated aortic valve replacement was evaluated on 5-year survival (p=0.62). Aortic valve replacement combined with CABG in very elderly patients resulted in similar 5-year survival compared to isolated aortic valve replacement (75.6% vs 82.4%; P=0.62).

synapsesocial.com/papers/6aab3bd2ce05be4d14475f0b https://doi.org/10.1093/ejcts/ezr029

Topics

Valvular heart disease

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Implication

Supports feasibility of combined AVR+CABG in very elderly without apparent survival penalty; leaves open need for randomized confirmation.

Aortic valve replacement with and without combined coronary bypass grafts in very elderly patients: early and long-term results

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Aortic valve replacement with and without combined coronary bypass grafts in very elderly patients: early and long-term results

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider