Abstract 4788: Long-Term Survival of the Very Elderly Undergoing Aortic Valve Surgery
Increasing numbers of the very elderly are undergoing aortic valve procedures. We describe the short and long-term survivorship for this cohort. We conducted a cohort study of 8,796 consecutive patients undergoing aortic valve surgery without (48.0%; AVR) or with (52.0%) concomitant coronary artery bypass graft (CABG) surgery (AVR-CABG) 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 strata and concomitant CABG surgery. During 44,,435 person years of follow-up, there were 3,236 deaths. Among AVR, there were 3,939 patients <80 yrs, 463 patients 80 – 84 yrs, and 174 patients 85 + yrs (29 patients ≥90 yrs). Among AVR-CABG patients, there were 3,312 patients <80 yrs, 656 patients 80 – 84 yrs, and 252 patients 85+ yrs (22 patients ≥90 yrs). Increasing age among patients undergoing isolated AVR was associated with female gender, more vascular disease and congestive heart failure, procedural urgency, while less diabetes. Increasing age among AVR-CABG patients was associated with female gender, left main stenosis, procedural urgency, more congestive heart failure, while less diabetes and lower ejection fraction. Median survivorship was better for patients undergoing AVR: 11.8 yrs (<80 yrs), 6.7 yrs (80 – 84 yrs), 6.1 yrs (85+yrs) than patients undergoing AVR-CABG: 9.3 yrs (<80 yrs), 6.3 yrs (80 – 84 yrs), and 5.6 yrs (85+ yrs), though this effect diminished with age. Octogenarians undergoing aortic valve surgery have a surprisingly favorable survivorship, with more than half of these patients still alive 6 years after their procedure. Concomitant CABG surgery diminishes this survivorship only slightly.