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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 5, September/October 2014
244
AFRICA
How to approach aortic valve disease in the elderly:
a 25-year retrospective study
Ebuzer Aydin, Ozge Altas Yerlikhan, Behzat Tuzun, Yucel Ozen, Sabit Sarikaya, Mehmet Kaan Kirali
Abstract
Objective:
In the last decade, the number of elderly patients
suffering from aortic valve disease has significantly increased.
This study aimed to identify possible factors that could affect
surgical and long-term outcomes in the light of a literature
review regarding the management of aortic valve disease in
the elderly.
Methods:
Between January 1990 and December 2012, a
total of 114 patients (64 males, 50 females; mean age 76.6
±
3.6 years; range 70–87 years) with aortic valve replacement
(AVR) alone, or combined with coronary artery bypass graft-
ing (CABG) or mitral surgery in our hospital, were retrospec-
tively analysed.
Results:
In-hospital mortality was seen in 19 patients. The
major causes of in-hospital mortality were low-cardiac output
syndrome in eight patients (42.1%), respiratory insufficiency
or infection in six (31.5%), multi-organ failure in four (21%),
and stroke in one patient (5.2%). The main postoperative
complications included arrhythmia in 26 patients (22.8%),
renal failure in 11 (9.6%), respiratory infection in nine (7.9%),
and stroke in three patients (2.6%). The mean length of inten-
sive care unit and hospital stays were 6.4
±
4.3 and 18
±
12.8
days, respectively. During follow up, late mortality was seen
in 28 patients (29.4%). Possible risk factors for long-term
mortality were type of prosthesis, EuroSCORE
≥
15, post-
operative pacemaker implantation, respiratory infection, and
haemodialysis. Among 65 long-term survivors, their activity
level was good in 53 (81.5%) and poor in two.
Conclusions:
Our study results demonstrated that an individu-
ally tailored approach including scheduled surgery increases
short- and long-term outcomes of AVR in patients aged
≥
70
years. In addition, shorter cardiopulmonary bypass time may
be more beneficial in this high-risk patient population.
Keywords:
aortic valve replacement, elderly, surgery, mortality
Submitted 27/4/14, accepted 18/8/14
Cardiovasc J Afr
2014;
25
: 244–248
www.cvja.co.zaDOI: 10.5830/CVJA-2014-051
The life expectancy of European and American populations has
been steadily increasing, now exceeding 80 years of age. Over the
past decade in Turkey, a modest increase has been achieved with
people now reaching 76 years.
1
In response to increased lifespan,
aortic valve replacement (AVR) has become widely accepted in
elderly patients.
Isolated AVR has been associated with an acceptable low
surgical mortality rate, with improved long-term survival
and quality of life.
2
Despite all improvements, concomitant
procedures and associated co-morbidities may result in high-risk
surgery, which led us to consider a transcatheter approach in
these patients.
In the last decade, the number of elderly patients aged 80
years or older suffering from aortic valve disease has significantly
increased. In this study, we aimed to identify possible factors
that may affect surgical and long-term outcomes in the light of
a literature review regarding the management of aortic valve
disease in the elderly.
Methods
This retrospective study included a total of 114 patients (64
males, 50 females; mean age 76.6
±
3.6 years; range 70–87 years)
with AVR alone, or combined with coronary artery bypass
grafting (CABG) or mitral valve surgery, admitted between
January 1990 and December 2012. The study was conducted in
accordance with the principles of Declaration of Helsinki. The
study protocol was approved by the institutional review board
(IRB) of Kartal Kosuyolu Training and Research Hospital
(IRB no: 538.38792-514.10-9472). Informed consent, which was
obtained from the patients, was confirmed by the IRB.
Bileaflet prostheses were mostly used, based on our experience
with mechanical valve implantation and due to the poor socio-
economic status of the country in those years. During 2012, all
accessible survivors were questioned to obtain data regarding
their health status, the presence of chest pain, functional grades
of dyspnoea [New York Heart Association (NYHA) class], and
quality of life. In total, 98.9% of the survivors (
n
=
64) completed
follow up through out-patient clinic visits or phone interviews.
Adverse events were defined according to the guidelines
for reporting morbidity and mortality after cardiac valvular
operations.
3
Surgical mortality was defined as any death,
irrespective of cause, occurring within 30 days of surgery in or
out of hospital,
4
and long-term mortality was defined as any
death occurring 30 days or more after surgery.
5
Postoperative
disease progression was defined as bleeding, poor cardiac status,
renal failure (transient or permanent need of haemodialysis),
neurological events, and prolonged duration of ventilatory
support/intensive care unit (ICU).
Data on the pre-, intra- and postoperative periods were
obtained from hospital charts. Of 95 hospital survivors, 47
visited the out-patient clinic on a regular basis.
Kartal Kosuyolu Training and Research Hospital, Istanbul,
Turkey
Ebuzer Aydin, MD,
ebuzermd@gmail.comOzge Altas Yerlikhan, MD
Behzat Tuzun, MD
Yucel Ozen, MD,
Sabit Sarikaya, MD
Mehmet Kaan Kirali, MD