Clinical presentation, surgical management, and outcomes of patients treated for aortic stenosis and coronary artery disease. Does age matter?

Background: Aortic stenosis and coronary artery disease (CAD) sharing similar risk factors are associated with aging of the human population.

Aim: The purpose of this study was to examine whether age affects clinical presentation, intraoperative management, and outcomes of patients who undergo simultaneous operations of aortic valve replacement (AVR) and coronary artery bypass grafting (CABG).

Methods: The study involved 452 consecutive patients aged 64.8 ± 8.2 years (range 38-79 years), who underwent combined AVR and CABG between 2005 and 2015. They were divided into three groups: Y (young; below the first quartile; n = 114), M (middle-aged; 58-71 years; n = 225) and E (elderly; above the third quartile; n = 113). Pre- and intraoperative variables were analysed. The deaths that occurred in hospital and throughout follow-up were defined as cardiac- or non-cardiac-related. The probability of survival was calculated with the use of Kaplan-Meier curves.

Results: Coronary artery disease was more extensive in group E than in group Y (p < 0.05). Complete myocardial revasculari-sation was performed in 94.1%, 76.2%, and 62.8% in groups Y, M, and E, respectively (p < 0.05). In-hospital mortality was 2.0%, 5.3%, and 6.4%, in groups Y, M, and E, respectively. Early morbidity was significantly higher in group E than in groups M or Y. The 12- and 60-month freedom from cardiac-related death was higher in group Y (0.98 ± 0.02 and 0.94 ± 0.03) than in group E (0.93 ± 0.02 and 0.85 ± 0.03; p = 0.023, respectively). Left ventricular ejection fraction below 0.4 and incomplete revascularisation were associated with worse prognosis, particularly in group E.

Conclusions: Elderly patients undergoing combined procedures of AVR and CABG having more extensive CAD less often receive complete revascularisation, are at higher risk of early organ failure, and present markedly reduced rates of freedom from cardiac-related deaths throughout follow-up than younger subjects.