Aortic valve replacement in elderly patients: Influence of concomitant coronary grafting on late survival

Background. Aortic valve replacement (AVR) has been an accepted therapy for elderly patients (>70 years) with aortic valve disease. This study was designed to investigate the determinants of survival after the implantation of aortic valve prostheses, with emphasis on the effect of concomitant coronary artery bypass grafting on survival. Methods. From November 1964 to July 1994, 963 elderly patients underwent isolated AVR. Long-term survival was investigated in 877 patients (70 to 94 years) who survived operation, with 92% follow-up completeness (mean ± standard deviation, 4.5 ± 3.9 years; maximum, 20.1 years; total, 3,920.2 patient-years), by univariate and multivariate analyses. Results. Actuarial survival was 38.1% ± 2.8% at 10 years, 17.8% ± 3.0% at 15 years, and 9.0% ± 3.1% at 20 years. Eight variables (age, sex, body surface area [less or greater than 1.7 m²], period of operation, type of prosthesis, size of prosthesis, re-replacement, and concomitant coronary artery bypass grafting) were investigated with regard to long-term survival by the Kaplan-Meier method. Age, sex, and body surface area were significant. Multivariate analysis revealed that older age (p = 0.0005) and male sex (p = 0.0001) were independent variables that determined long-term survival. Conclusions. Elderly patients may have satisfactory long- term results after AVR. Age and sex are independent determinants. Other factors (such as concomitant coronary artery bypass grafting and type of prosthesis) did not independently influence long-term survival. Coronary revascularization in elderly patients with coronary disease undergoing AVR may lead to a long-term survival similar to that in patients without coronary disease undergoing AVR.