Original article
Adult cardiac
Tissue Versus Mechanical Prostheses: Quality of Life in Octogenarians

https://doi.org/10.1016/j.athoracsur.2007.12.039Get rights and content

Background

The aim of this study was to determine whether changes in prognosis and quality of life (QOL) after aortic valve replacement (AVR) in octogenarians differ depending on the choice of mechanical (MP) or tissue (BP) valves.

Methods

Between July 1992 and September 2006, 160 consecutive octogenarians underwent AVR with (18.8%) or without concomitant coronary artery bypass grafting. At follow-up (mean 3.4 ± 2.8 years, 552 patient-years, 98.3% complete), 121 were still alive and answered the Medical Outcomes Study Short-Form 36 Health Survey (SF-36) QOL questionnaire.

Results

Group BP had 62 patients. Group MP had 98 patients. Preoperative risk factors were comparable except group BP was older. Global hospital mortality was 8.8%. There were 21 late deaths, 61.9% of which were not valve- or anticoagulation-related. A significant difference emerged in 1-, 3-, 5- and 8-year actuarial survival rates (BP: 86.4% ± 0.04%, 76.9% ± 0.06%, 58.1% ± 0.1%, 46.5% ± 0.14%, respectively, vs MP: 91.3% ± 0.03%, 88.6% ± 0.03%, 81.6% ± 0.05%, 70% ± 0.67%; p = 0.025) but not in terms of 8-year freedom from valve-related complications (82.6% ± 0.1% vs 87% ± 0.053%, p = 0.55). One anticoagulant-related hemorrhage occurred in group MP; one stroke occurred in group BP. Survivors had significant improvement in New York Heart Association functional class compared with preoperatively (1.1 vs 2.8, p < 0.001) Mean QOL scores were satisfactory and substantially comparable between the two groups; in seven domains, scores were higher than those of the age- and sex-matched general Italian population.

Conclusions

Long-term survival after AVR in selected octogenarians was similar to that of the general elderly population. The device type exerted no influence on QOL.

Section snippets

Study Population and Prosthesis Selection Criteria

Between July 1992 and September 2006, 160 consecutive octogenarians underwent AVR for aortic valve stenosis at our institution. Patients receiving concomitant coronary artery bypass grafting (CABG) were also enrolled. The study population was divided into two groups: group BP included patients who received a biologic valve implantation, and group MP included patients who received a mechanical valve.

The choice of the type of valve substitute for an octogenarian patient was fundamentally guided

Study Population and Hospital Mortality

The study population consisted of 69 men and 91 women with a mean age of 82.3 ± 2.3 years (range, 80 to 90 years). Group BP comprised 68 patients and group MP had 92. Group BP patients were older, with a mean age of 82.9 ± 2.7, whereas the mean age of group MP was 81.8 ± 1.8 years (p = 0.003). Global hospital mortality was 8.8% (14 patients): 7 patients died in group BP (10.3%) and 7 in group MP (7.6%; p = 0.75). The proportion of early cardiac death between the two groups was not statistically

Comment

The growing of the number of octogenarians referring to cardiac operations has increased the attention on the outcomes in this subset of patients. A rigorous analysis of an institution’s results after AVR in very old patients should focus on three questions:

  • 1

    Do surgical procedures have an acceptable rate of hospital mortality in the 80th decade of life?

  • 2

    Are there improvements in survival and QOL after intervention in patients aged 80 years and older?

  • 3

    Is there a prosthesis of choice for

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    Copyright © 2008 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.