Elsevier

American Heart Journal

Volume 164, Issue 3, September 2012, Pages 410-418.e1
American Heart Journal

Clinical Investigation
Valvular and Congenital Heart Disease
Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: A systematic review and meta-analysis of 40 studies

https://doi.org/10.1016/j.ahj.2012.06.019Get rights and content

Aim

This study was planned to evaluate the outcome of patients aged ≥80 years undergoing combined conventional aortic valve replacement (AVR) and coronary artery bypass grafting (CABG).

Methods

This is a systematic review of the literature and meta-analysis of data on patients aged ≥80 years who underwent combined AVR and CABG.

Results

The literature search yielded 40 observational studies reporting on 8,975 patients aged ≥80 years. Pooled proportion of immediate postoperative mortality was 9.7% (95% CI 8.4-11.1, 40 studies, 8,975 patients). Immediate mortality was 8.2% (95% CI 6.5-10.0) in 15 studies with a mid-date from 2000 to 2007 and 10.8% (95% CI 9.1-12.7) in 25 studies with a mid-date from 1982 to 1999 (P = .043). Postoperative stroke rate was 3.7% (95% CI 2.8-4.8, 12 studies, 2,770 patients), and postoperative implantation of pacemaker was 4.3% (95% CI 2.6-6.5, 5 studies, 535 patients). The mean length of stay in intensive care unit was 5.3 days (95% CI 3.3-7.3, 5 studies, 490 patients), and the mean length of in-hospital stay was 16.9 days (95% CI 12.4-21.4, 5 studies, 424 patients). One-, 3-, 5- and 10-year pooled survival rates after combined AVR and CABG were 83.2%, 72.9%, 60.8%, and 25.7%, respectively.

Conclusions

Conventional AVR and CABG in patients aged ≥80 years are associated with significant operative mortality and morbidity as well as prolonged in-hospital treatment. However, conventional surgery is associated with remarkably good late survival. This suggests that any alternative treatment modality must prove itself of being enough durable also in the very elderly.

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

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