| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;78:755
© 2004 The Society of Thoracic Surgeons
Department of Cardiothoracic Surgery, United Kingdom Heart Valve Registry, Hammersmith HospitalDu Cane Rd, London W12 0NN, UK
e-mail: m.b.edwards{at}ic.ac.uk
e-mail: k.m.taylor{at}ic.ac.uk
To the Editor:
We welcome the comments of Dr Legare and colleagues. We agree with them that the expectations of nonagenarian patients who undergo a heart valve operation can differ from their younger counterparts and that quality of life rather than longevity becomes more important in this age group.
Our study examined outcomes in terms of early mortality (ie, death within 30 days or less after operation) and longer-term survival in 35 consecutive patients aged 90 years or more who underwent heart valve replacement in the United Kingdom (UK) [1]. To our knowledge, this is the largest study of nonagenarian patients undergoing valve replacement, and unlike other studies reporting results from selected and single institutions, this study is a national study. All UK cardiac centers submit all their data on valve replacement operations to the UK Heart Valve Registry, and as our study analyzed data from the Registry, it reflects the results of a number of surgeons from a number of institutions practicing several different surgical techniques and protocols. Furthermore, all patients on the UK Heart Valve Registry database are tracked by the national agency responsible for registering all deaths of UK nationals, and in the event a registered patient dies, the Registry receives a copy of the death certificate, which records the exact date, place, certified cause of death, and whether postmortem examination was conducted. Therefore, the outcomes of valve replacement operations in the UK as a whole are centrally and independently analyzed and do not fall victim to the usual individual study biases. The Registry is able to report accurately on the occurrence of reoperation, early mortality, and long-term survival for all UK patients having valve replacement.
One of the limitations acknowledged in the Material and Methods section of the report and mentioned by Dr Legare and colleagues is that detailed information on length of stay, morbidity, New York Heart Association status, and other preclinical factors was difficult to obtain for all 35 patients. However, we were able to get the medical records for 18 of the 35 patients, which is comparable with other studies and they provided valuable preoperative, intraoperative, and postoperative data. Furthermore, detailed information was available for all 35 nonagenarian patients on variables such as age, sex, valve site, valve type, ie, mechanical versus bioprosthetic, concomitant coronary artery bypass grafting, operative priority, early mortality, and longer-term survival. We agree with Dr Legare and co-authors that one must be careful when aggregating the data and results from different studies to evaluate the outcomes of surgical valvular procedures in nonagerians. However, because data are collected uniformly throughout the UK, we are able to identify the study's limitations and factor these into the analyses. Thus, we believe the data can act as a benchmark for surgical performance, certain risk factors, and expected outcomes in patients undergoing valve operations.
References
This article has been cited by other articles:
|
|
 |
|
  M. Porizka, M. Stritesky, M. Semrad, M. Dobias, A. Dohnalova, and J. Korinek Standard blood flow rates of cardiopulmonary bypass are adequate in awake on-pump cardiac surgery Eur J Cardiothorac Surg, April 1, 2011; 39(4): 442 - 450. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
