Combined Valve and Coronary Artery Bypass Procedures in Septuagenarians and Octogenarians: Results in 119 Patients
A consecutive series of 96 septuagenarians (Group I, mean age 74) and 23 octogenarians (Group II, mean age 83) underwent coronary artery bypass (CAB, mean 2.6 grafts per patient) and valve operations using hypothermia and hyperkalemic cardioplegia in a 45-month period. Most patients (57% of Group I and 91% of Group II) were in New York Heart Association (NYHA) Class IV preoperatively. The early deaths were 19% for Group I and 39% for Group II; late deaths were 13% and 30%, respectively (mean 25 months). Of 91 survivors, 86% of Group I and 71% of Group II improved by one or more NYHA Classes postoperatively. Overall, of 56 patients with combined CAB and aortic valve replacement, 19 (33%) died; of 38 with combined CAB and mitral valve replacement, 23 (61%) died; 3 of 13 (23%) with combined CAB and double valve replacement died; and 3 of 12 (25%) with CAB and mitral valve repair died. In comparison, among patients less than 70 years of age having isolated valve replacement in the same period, 2 of 30 (7%) in the AVR group died, 5 of 17 (29%) in the MVR group died, and 2 of 7 (33%) in the DVR group died. The risk of combined valve procedures and bypass surgery was significantly increased in the elderly and may warrant a less aggressive procedure, especially in the mitral position.
KeywordsValve Replacement Aortic Valve Replacement Coronary Bypass Mitral Valve Replacement Mitral Valve Repair
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