Clinical InvestigationValvular and Congenital Heart DiseaseOutcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: A systematic review and meta-analysis of 40 studies
Section snippets
Materials and methods
An English language literature review was performed through PubMed, Scopus, and Science Direct up to March 2012 for any study evaluating the outcome after combined AVR and CABG in patients aged ≥80 years. The words used in the search were: “aortic valve replacement,” “coronary artery bypass surgery,” “octogenarian,” “nonagenarian,” and “80 years old.” Reference lists of obtained articles were searched as well.
Literature search
The literature search yielded 3,620 articles, of which 925 were found to be pertinent with the topic of interest. Forty articles2, 3, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 reporting on 8,975 patients aged ≥80 years who underwent combined AVR and CABG fulfilled the inclusion criteria and were included in the present study (Figure 1). All the included studies contributed to analysis of
Discussion
As the number of very elderly affected by aortic valve stenosis and coronary artery disease is likely to significantly increase in the near future, there is a need for data providing evidence of the risks and benefits of currently available methods for combined treatment of these 2 diseases. Although combined AVR and CABG remains the treatment of choice in patients with significant aortic valve stenosis and coronary artery disease,51 the present findings demonstrate that octogenarians
References (71)
- et al.
Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up
J Am Coll Cardiol
(1991) - et al.
Clinical factors associated with calcific aortic valve disease
J Am Coll Cardiol
(1997) - et al.
Coronary artery bypass surgery in octogenarians: long-term outcome can be better than expected
Ann Thorac Surg
(2010) - et al.
Immediate and late outcome of patients aged 80 years and older undergoing isolated aortic valve replacement: A systematic review and meta-analysis of 48 studies
Am Heart J
(2012) - et al.
Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network
J Am Coll Cardiol
(2000) - et al.
Outcome after aortic valve replacement in octogenarians
Ann Thorac Surg
(2004) - et al.
601 octogenarians undergoing cardiac surgery: outcome and comparison with younger age groups
Ann Thorac Surg
(1999) - et al.
Aortic valve replacement for aortic stenosis in persons aged 80 years and over
Am J Cardiol
(1991) - et al.
Risk stratification for cardiac valve replacement. National Cardiac Surgery Database. Database Committee of The Society of Thoracic Surgeons
Ann Thorac Surg
(1999) - et al.
Twenty years of cardiac surgery in patients aged 80 years and older: risks and benefits
Ann Thorac Surg
(2011)
Aortic valve replacement in the elderly: the real life
Ann Thorac Surg
Frailty after aortic valve replacement (AVR) in octogenarians
Arch Gerontol Geriatr
Aortic valve replacement with or without coronary artery bypass graft surgery: the risk of surgery in patients > or =80 years old
J Cardiothorac Vasc Anesth
Aortic valve replacement for octogenarians: are small valves bad?
Ann Thorac Surg
Outcomes of aortic valve replacement performed by residents in octogenarians
J Surg Res
Valve structure and survival in octogenarians having aortic valve replacement for aortic stenosis (+/− aortic regurgitation) with versus without coronary artery bypass grafting at a single US medical center (1993 to 2005)
Am J Cardiol
Ten-year experience of cardiac surgery in patients aged 80 years and over
Ann Thorac Surg
Early and late results of isolated and combined heart valve surgery in patients > or = 80 years of age
Am J Cardiol
Society of Thoracic Surgeons Risk Score predicts hospital charges and resource use after aortic valve replacement
J Thorac Cardiovasc Surg
Off-pump bilateral skeletonized internal thoracic artery grafting in elderly patients
Ann Thorac Surg
Transapical aortic valve implantation in high-risk patients with severe aortic valve stenosis
Ann Thorac Surg
Tolerance to ischemia and hypoxia is reduced in aged human myocardium
J Thorac Cardiovasc Surg
Determinants of early and late results of combined valve operations and coronary artery bypass grafting
Ann Thorac Surg
Effect of sutureless implantation of the Perceval S aortic valve bioprosthesis on intraoperative and early postoperative outcomes
J Thorac Cardiovasc Surg
Effect of concomitant coronary artery disease on procedural and late outcomes of transcatheter aortic valve implantation
Ann Thorac Surg
Comparison of outcomes in patients having isolated transcatheter aortic valve implantation versus combined with preprocedural percutaneous coronary intervention
Am J Cardiol
EuroSCORE predicts immediate and late outcome after coronary artery bypass surgery
Ann Thorac Surg
Cardiac operations in patients 80 years old and older
Ann Thorac Surg
Determinants of occurrence of aortic sclerosis in an aging population
JACC Cardiovasc Imaging
Cardiac valve surgery in the octogenarian
Heart
Meta-analysis of observational studies in epidemiology. A proposal for reporting
JAMA
Practical methods for incorporating summary time-to-event data into meta-analysis
Trials
Transformations related to the angular and the square root
Ann Math Stat
A language and environment for statistical computing
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2017, Cor et VasaCitation Excerpt :The prevalence observed in our series is comparable to previous studies [3,11–17], and confirms the importance of this clinical variable in the decision-making and strategic management of TAVI in high-risk patients. Associated CAD strongly impacts the clinical prognosis of patients with AVS [18] and simultaneous myocardial revascularization at the time or SVR is strongly recommended despite a higher peri-operative risk, outweighed however by the long-term benefits of the combined coronary surgery when compared to the AVR alone [19]. Given the relatively recent implementation of TAVI as a therapeutic option for high-risk patients with AVS, there are no available recommendations as to the management of associated CAD.
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