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Aortic valve replacement with and without concomitant coronary artery bypass surgery in the elderly: risk factors related to long-term survival.

AIM
Preoperative coronary angiography often reveals significant coronary artery lesions in elderly people (>75 years of age) referred to hospital for aortic valve replacement (AVR). However, the possible benefit of concomitant coronary artery bypass grafting (CABG) in elderly is still under debate. In an effort to contribute to this discussion, we evaluated our data on elderly patients after aortic valve replacement.


METHODS
Between January 1990 and December 1993, 219 patients, aged 75 years and older, underwent AVR with or without concomitant CABG at our Department. There were 121 patients in the AVR group and 98 patients in the AVR+CABG group. There was no significant difference between the two groups in their age, sex valve type, valve size, and presence of diabetes. Five variables (concomitant CABG, age, sex, and type and size of prosthesis) were investigated with regard to long-term survival assessed by the Kaplan-Meier analysis. Group comparisons of survival were made with the Cox-Mantel log-rank test.


RESULTS
Early mortality (<30 days) was 0.8% in the AVR group and 4.1% in the AVR+CABG group. Overall actuarial survival was 77.7+/-4.4% at 52 months. There was significantly longer survival in patients with mechanical valve implant in the AVR group. None of the other 5 investigated variables had a significant influence on the long-term survival.


CONCLUSION
Our results suggest that AVR done in elderly is a treatment with excellent surgical results. We could not identify concomitant CABG as a predictor of poor long-term surgical outcome.