Reoperative valve surgery in the elderly: Predictors of risk and long-term survival

Leora B. Balsam, Eugene A. Grossi, David G. Greenhouse, Patricia Ursomanno, Abelardo Deanda, Greg H. Ribakove, Alfred T. Culliford, Aubrey C. Galloway

Research output: Contribution to journalArticle

69 Scopus citations

Abstract

Background: Elderly patients requiring reoperative cardiac surgery for valve disease are considered high risk for immediate outcomes, but little is known about their long-term survival. It is often conjectured that medical therapy provides equivalent late survival in this population, which may dissuade both patient and surgeon from considering reoperation. We analyzed a cohort of such patients undergoing reoperative valve surgery to determine their long-term survival. Methods: From 1992 through 2007, 363 patients aged 75 years or more underwent reoperative isolated valve surgery; 211 (58%) had aortic valve replacement and 152 (42%) had mitral valve surgery. Mean age was 80.5 years. Hospital outcomes were prospectively recorded. Survival from all-cause death was determined from the Social Security Death Index. Results: Hospital mortality was 13.8% (12.8% for aortic and 15.1% for mitral valve operations; p = 0.52). Multivariable predictors of hospital death were New York Heart Association functional class III or IV heart failure (odds ratio = 3.19, p = 0.012), dialysis (odds ratio = 15.63, p = 0.003), and more than one reoperation (odds ratio = 2.59, p = 0.058). At 5 years, overall survival was 62% ± 3% for all patients (66% ± 4% for aortic and 56% ± 4% for mitral valve patients). For aortic valve patients aged 80 years or more, 5-year survival was 60% ± 0.6%. Life expectancy table analysis predicted a 5-year survival of 57% for an age-matched and sex-matched comparison group. Conclusions: Reoperative surgery for elderly patients with isolated aortic or mitral valve pathology is associated with excellent long-term survival, particularly when treating aortic valve disease. While in-hospital mortality is higher among the elderly than among younger patients, specific predictors of poor outcome can be identified preoperatively to risk stratify these patients.

Original languageEnglish (US)
Pages (from-to)1195-1201
Number of pages7
JournalAnnals of Thoracic Surgery
Volume90
Issue number4
DOIs
StatePublished - Oct 2010

    Fingerprint

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Balsam, L. B., Grossi, E. A., Greenhouse, D. G., Ursomanno, P., Deanda, A., Ribakove, G. H., Culliford, A. T., & Galloway, A. C. (2010). Reoperative valve surgery in the elderly: Predictors of risk and long-term survival. Annals of Thoracic Surgery, 90(4), 1195-1201. https://doi.org/10.1016/j.athoracsur.2010.04.057