Abstract
Background We sought to determine the long-term results of stentless biological heart valve
replacement in octogenarians to find out whether coronary artery disease or the coronary
artery bypass grafting (CABG) procedure itself influences survival in these aged patients.
Methods From 4,012 patients undergoing aortic valve replacement (AVR) with a stentless prosthesis
(Freestyle, Medtronic) at a single center, 721 patients were older than 80 years.
They had a mean age of 83 ± 2 (2,320 patient years), the male/female ratio was 42:58,
NYHA (New York Heart Association) class I and II was prevalent in 22.8%, preoperative
atrial fibrillation (AF) in 20.6%, coronary artery disease in 56.1%, mitral valve
disease in 12.5%, and aortic disease in 3.5%. Follow-up included a total of 11,546
patient years (mean follow-up time: 74 ± 53 months); follow-up mortality data were
96.3% complete.
Results In these aged patients, 30-day mortality in the isolated AVR group (10.3%) was similar
to that in the AVR + CABG group (13.4%). Although long-term survival (15 years) in
the octogenarian population is low (9% in the AVR group and 6% in the AVR + CABG group),
it was not different (p = 0.191) between patients with and without coronary artery disease. The stroke rate
and the myocardial infarction rate, respectively, in the AVR + CABG group (0.43%/100
patient years and 0.17%/100 patient years) were only insignificantly higher than that
in the isolated AVR group (each 0.01%/100 patient years). The actuarial freedom from
reoperation was 99% in both the groups.
Conclusion Use of the Freestyle stentless valve prosthesis for AVR is feasible also in octogenarians.
The existence of coronary artery disease leads to concomitant bypass surgery, but
not a higher level of perioperative or long-term mortality.
Keywords
octogenarians - aortic valve replacement - heart valve surgery - stentless bioprosthesis
- coronary artery disease
