AORTIC-VALVE REPLACEMENT IN ELDERLY PATIENTS - INFLUENCE OF CONCOMITANT CORONARY GRAFTING ON LATE SURVIVAL

Background. Aortic valve replacement (AVR) has been an accepted therap y for elderly patients (> 70 years) with aortic valve disease. This st udy was designed to investigate the determinants of survival after the implantation of aortic valve prostheses, with emphasis on the effect of concomitant coronary artery bypass grafting on survival. Methods. F rom November 1964 to July 1994, 963 elderly patients underwent isolate d AVR. Long-term survival was investigated in 877 patients (70 to 94 y ears) who survived operation, with 92% follow-up completeness (mean +/ - standard deviation, 4.5 +/- 3.9 years; maximum, 20.1 years; total, 3 ,920.2 patient-years), by univariate and multivariate analyses. Result s. Actuarial survival was 38.1% +/- 2.8% at 10 years, 17.8% +/- 3.0% a t 15 years, and 9.0% +/- 3.1% at 20 years. Eight variables (age, sex, body surface area [less or greater than 1.7 m(2)], period of operation , type of prosthe-sis, size of prosthesis, ie-replacement, and concomi tant coronary artery bypass grafting) were investigated with regard to long-term survival by the Kaplan-Meier method. Age, sex, and body sur face area were significant. Multivariate analysis revealed that older age (p = 0.0005) and male sex (p = 0.0001) were independent variables that determined long-term survival. Conclusions. Elderly patients may have satisfactory long-term results after AVR. Age and sex are indepen dent determinants. Other factors (such as concomitant coronary artery bypass grafting and type of prosthesis) did not independently influenc e long-term survival. Coronary revascularization in elderly patients w ith coronary disease undergoing AVR may lead to a long-term survival s imilar to that in patients without coronary disease undergoing AVR.