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

66 Citations (Scopus)

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)1195-1200
Number of pages6
JournalAnnals of Thoracic Surgery
Volume90
Issue number4
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Survival
Aortic Valve
Mitral Valve
Odds Ratio
Hospital Mortality
Reoperation
Aortic Diseases
Life Tables
Social Security
Heart Valves
Life Expectancy
Thoracic Surgery
Dialysis
Cause of Death
Research Design
Heart Failure
Pathology
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Balsam, L. B., Grossi, E. A., Greenhouse, D. G., Ursomanno, P., DeAnda, A., Ribakove, G. H., ... Galloway, A. C. (2010). Reoperative valve surgery in the elderly: Predictors of risk and long-term survival. Annals of Thoracic Surgery, 90(4), 1195-1200. https://doi.org/10.1016/j.athoracsur.2010.04.057

Reoperative valve surgery in the elderly : Predictors of risk and long-term survival. / Balsam, Leora B.; Grossi, Eugene A.; Greenhouse, David G.; Ursomanno, Patricia; DeAnda, Abelardo; Ribakove, Greg H.; Culliford, Alfred T.; Galloway, Aubrey C.

In: Annals of Thoracic Surgery, Vol. 90, No. 4, 2010, p. 1195-1200.

Research output: Contribution to journalArticle

Balsam, LB, Grossi, EA, Greenhouse, DG, Ursomanno, P, DeAnda, A, Ribakove, GH, Culliford, AT & Galloway, AC 2010, 'Reoperative valve surgery in the elderly: Predictors of risk and long-term survival', Annals of Thoracic Surgery, vol. 90, no. 4, pp. 1195-1200. https://doi.org/10.1016/j.athoracsur.2010.04.057
Balsam, Leora B. ; Grossi, Eugene A. ; Greenhouse, David G. ; Ursomanno, Patricia ; DeAnda, Abelardo ; Ribakove, Greg H. ; Culliford, Alfred T. ; Galloway, Aubrey C. / Reoperative valve surgery in the elderly : Predictors of risk and long-term survival. In: Annals of Thoracic Surgery. 2010 ; Vol. 90, No. 4. pp. 1195-1200.
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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.",
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AU - Balsam, Leora B.

AU - Grossi, Eugene A.

AU - Greenhouse, David G.

AU - Ursomanno, Patricia

AU - DeAnda, Abelardo

AU - Ribakove, Greg H.

AU - Culliford, Alfred T.

AU - Galloway, Aubrey C.

PY - 2010

Y1 - 2010

N2 - 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.

AB - 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.

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