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Benjamin Medalion
Bruce W. Lytle
Patrick M. McCarthy
Robert W. Stewart
John H. Arnold
Floyd D. Loop
Delos M. Cosgrove, III
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Ann Thorac Surg 1998;66:699-706
© 1998 The Society of Thoracic Surgeons

Original articles: Cardiovascular

Aortic valve replacement for octogenarians: are small valves bad?

Benjamin Medalion, MDa,b, Bruce W. Lytle, MDa,b, Patrick M. McCarthy, MDa,b, Robert W. Stewart, MDa,b, Kristopher L. Arheart, EdDb, John H. Arnold, MDa,b, Floyd D. Loop, MDa,b, Delos M. Cosgrove, III, MDa,b

a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
b Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Address reprint requests to Dr Lytle, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, F25, Cleveland, OH 44195

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.

Background. As the population ages, more octogenarians become candidates for aortic valve replacement. Many octogenarians, particularly women, have a small aortic annulus and there is uncertainty as to the optimal management of this situation in that age group.

Method. To examine this issue, we reviewed 248 octogenarians (mean age, 82.6 ± 2.3 years; 58% men) who underwent primary isolated aortic valve replacement (n = 99), or aortic valve replacement and coronary revascularization (n = 149), between 1980 and 1995. Nineteen-millimeter valves were used in 26% of the patients.

Results. In-hospital mortality was 8.9%, 5% for aortic valve replacement alone and 11.4% for aortic valve replacement and coronary revascularization. It was 12.5% for the 19-mm size valves compared with 7.7% for the bigger size valves (p = 0.24). Follow-up (mean interval, 4.4 years) demonstrated survival for all patients of 85%, 60%, and 30% and survival free from cardiovascular events of 80%, 45%, and 21% at 1, 5, and 10 postoperative years, respectively. Multivariate analysis identified triple-vessel disease and preoperative congestive heart failure as associated with increased risk for both in-hospital and late mortality (p < 0.05). Valve size did not influence late survival or event-free survival regardless of body surface area.

Conclusions. The use of small aortic valve prostheses in octogenarians does not adversely affect the incidence of early or late mortality or cardiac events.




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