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Vol. 215. Issue 3.
Pages 148-155 (April 2015)
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Vol. 215. Issue 3.
Pages 148-155 (April 2015)
Original article
Aortic valve surgery in octogenarians: Risk factors and long-term impact
Cirugía de la válvula aórtica en octogenarios: factores de riesgo e impacto a largo plazo
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Y. Carrascal
Corresponding author
ycarrascal@hotmail.com

Corresponding author.
, H. Valenzuela, G. Laguna, P. Pareja, M. Blanco, C. Ortega
Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Tables (3)
Table 1. Characteristics of patients older than 80 years undergoing extracorporeal aortic valve surgery between 2000 and 2013.
Table 2. Morbidity in octogenarians after aortic valve replacement surgery, isolated or combined with myocardial revascularization.
Table 3. Risk factors for main postoperative complications of octogenarian patients after heart surgery for aortic valve replacement, with or without associated myocardial revascularization. For the multivariate analysis, we included the significant variables (p<.05) in the univariate analysis and those with p<.2. The variables included in each case are indicated with an asterisk.
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Abstract
Background and objectives

To understand the risk factors and long-term impact and results of aortic valve surgery in patients over age 80.

Patients and methods

We consecutively evaluated 255 octogenarians who were operated on between 2000 and 2013 and referred for aortic valve disease (isolated or combined with coronary artery disease), which, even when associated with other diseases, was the primary cause of the patient's functional limitation.

Results

The mortality rate decreased from 14.08% (2000–2004) to 7.7% (isolated valve surgery, 4.4%; with coronary bypass, 3.3%) (2010–2013). The independent risk factors associated with mortality were urgent surgery, combined procedures, peripheral vascular disease, a postsurgery hematocrit level <24% and the need for transfusion. More than 50% of the patients experienced a postoperative complication. Blood product transfusions were associated with renal and respiratory failure, and preoperative anemia was associated with an increased rate of myocardial infarction and stroke. Survival at 1, 3, 5 and 10 years was 79.5, 74.3, 63.6 and 30.5%, respectively, with 91.5% of the patients in NYHA functional class I–II. Long-term survival was lower for cases of preoperative left ventricular dysfunction. The EuroSCORE I logistics score was not useful for our population as a predictor of mortality or of medium to long-term survival.

Conclusions

The morbidity and mortality of aortic valve surgery for patients over age 80 has decreased in recent years, although it remains higher when valve surgery is combined with coronary surgery. The presence of preoperative left ventricular dysfunction decreases long-term survival.

Keywords:
Extracorporeal circulation
Surgery
Geriatric medicine
Aortic valve
Resumen
Antecedentes y objetivos

Conocer los factores de riesgo, resultados e impacto a largo plazo de la cirugía valvular aórtica en pacientes con más de 80 años.

Pacientes y métodos

Evaluamos 255 octogenarios consecutivos, intervenidos entre 2000 y 2013, y remitidos por valvulopatía aórtica (aislada o combinada con enfermedad coronaria) que, aun asociada a otras patologías, era la causa principal de limitación funcional del paciente.

Resultados

La mortalidad se redujo del 14,08% (periodo 2000–2004) al 7,7% (cirugía valvular aislada, 4,4% y con bypass coronario, 3,3%) (periodo 2010–2013). La cirugía urgente, los procedimientos combinados, la enfermedad vascular periférica, un hematocrito postquirúrgico <24% y la necesidad de transfusión, fueron factores de riesgo independientes asociados a la mortalidad. Más del 50% de los pacientes presentó alguna complicación postoperatoria. La transfusión de hemoderivados se asoció a insuficiencia renal y respiratoria, y la anemia preoperatoria a mayor frecuencia de infarto de miocardio e ictus. La supervivencia a 1, 3, 5 y 10 años fue del 79,5; 74,3; 63,6 y 30,5%, respectivamente, con un 91,5% de los pacientes en clase funcional NYHA I-II. La supervivencia a largo plazo se redujo en caso de disfunción ventricular izquierda preoperatoria. La puntuación EuroSCORE I logística no resultó útil en nuestra población como predictor de mortalidad ni de supervivencia a medio-largo plazo.

Conclusiones

La morbimortalidad de la cirugía valvular aórtica en los pacientes con más de 80 años ha descendido en los últimos años, aunque sigue siendo superior cuando la cirugía valvular se asocia a cirugía coronaria. La presencia de disfunción ventricular izquierda preoperatoria disminuye la supervivencia a largo plazo.

Palabras clave:
Circulación extracorpórea
Cirugía
Geriatría
Válvula aórtica

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