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(Circulation. 2009;120:S127-S133.)
© 2009 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Long-Term Survival of the Very Elderly Undergoing Aortic Valve Surgery

Donald S. Likosky, PhD; Meredith J. Sorensen, MD; Lawrence J. Dacey, MD; Yvon R. Baribeau, MD; Bruce J. Leavitt, MD; Anthony W. DiScipio, MD; Felix Hernandez, Jr, MD; Richard P. Cochran, MD; Reed Quinn, MD; Robert E. Helm, MD; David C. Charlesworth, MD; Robert A. Clough, MD; David J. Malenka, MD; Donato A. Sisto, MD; Gerald Sardella, MD; Elaine M. Olmstead, BA; Cathy S. Ross, MS; Gerald T. O'Connor, DSc, PhD, for the Northern New England Cardiovascular Disease Study Group

From the Departments of Medicine, Surgery, and Community and Family Medicine (D.L., M.J.S., L.J.D., A.W.D., D.M., E.M.O., C.S.R., G.T.O.) and The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH; the Department of Surgery (Y.R.B., D.C.C.), Catholic Medical Center, Manchester, NH; the Department of Surgery (B.J.L.), Fletcher Allen Health Care, Burlington, Vt; the Department of Surgery (F.H., R.A.C.), Eastern Maine Medical Center, Bangor, Me; the Department of Surgery (R.P.C.), Central Maine Medical Center, Lewiston, Me; the Department of Surgery (R.Q.), Maine Medical Center, Portland, Me; the Department of Surgery (R.E.H., D.A.S.), Portsmouth Regional Hospital, Portsmouth, NH; and the Department of Surgery (G.S.), Concord Hospital, Concord, NH.

Correspondence to Donald S. Likosky, PhD, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756. E-mail donald.likosky{at}dartmouth.edu

Background— Increasing numbers of the very elderly are undergoing aortic valve procedures. We describe the short- and long-term survivorship for this cohort.

Methods and Results— We conducted a cohort study of 7584 consecutive patients undergoing open aortic valve surgery without (51.1%; AVR) or with (48.9%; AVR + CABG) concomitant coronary artery bypass graft surgery between November 10, 1987 through June 30, 2006. Patient records were linked to the Social Security Administration’s Death Master File. Survivorship was stratified by age and concomitant CABG surgery. During 39 835 person-years of follow-up, there were 2877 deaths. Among AVR, there were 3304 patients <80 years of age, 419 patients 80 to 84 years, and 156 patients 85 years (24 patients >90 years). Among AVR+CABG patients, there were 2890 patients <80 years of age, 577 patients 80 to 84 years, and 238 patients 85 years (22 patients >90 years). Median survivorship for patients undergoing isolated AVR was 11.5 years (<80 years), 6.8 years (80 to 84 years), 6.2 years (85 years); for patients undergoing AVR+CABG, median survivorship was 9.4 years (<80 years), 6.8 years (80 to 84 years), and 7.1 years (85 years). Among both procedures, adjusted survivorship was significantly different across strata of age (P<0.001). These findings are similar to life expectancy of the general population from actuarial tables: 80 to 84 years (7 years) and 85 years (5 years).

Conclusions— Survivorship among octogenarians is favorable, with more than half the patients surviving more than 6 years after their surgery. Concomitant CABG surgery does not diminish median survivorship among patients >80 years of age.

Key Words: valves • coronary disease • survival • aging