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Treatment and outcomes of severe cardiac disease with surgical indication in very old patients.

Abstract：

OBJECTIVE:To describe and compare the crude and risk-adjusted survival of a series of octogenarians with symptomatic severe aortic stenosis (SAS) or severe coronary artery disease (SCAD). METHODS:We reviewed the treatment and outcomes of 130 consecutive patients > or = 80 years old hospitalized for SAS or SCAD. RESULTS:Mean age was 82.8+/-3.1 years, 52% were women. Of 83 patients with SCAD, 52 were treated by coronary stenting (63%), 12 by coronary artery bypass grafting (15%) and 19 medically (23%). There were no significant differences in baseline characteristics among different treatment groups. When comparing the medically treated group with the intervention group (coronary artery bypass grafting or stenting), the former showed a trend to a worse prognosis (adjusted HR 2.5, 95% CI 0.98-6.6, p=0.056). Of 47 patients treated with SAS, 33 were treated surgically (70%), 26 by aortic valve replacement (AVR) alone and 7 combined with coronary revascularization. Fourteen patients were treated medically (30%). Patients treated with AVR were younger, presented less frequently a previous MI and had better left ventricular systolic function. Multivariate analysis did not find AVR associated to a better survival (HR 1.1, 95% CI 0.2-5.4). CONCLUSION:Cardiac surgery in octogenarians is more frequently performed in patients with SAS than in patients with SCAD, but survival benefit is probably greater in the latter. A more conservative approach with medical therapy in patients with SAS and coronary stenting in patients with SCAD are alternatives that should be considered.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Martínez-Sellés M,Hortal J,Barrio JM,Ruiz M,Bueno H

doi

10.1016/j.ijcard.2006.06.057

subject

Has Abstract

pub_date

2007-06-25 00:00:00

pages

15-20

issue

1

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(06)00871-0

journal_volume

119

pub_type

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