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Aortic Valve Replacement In Octogenarians: Impact Of Less Invasivity On Postoperative Outcome
Tarek Alameddine.
Sultan Qaboos University Hospital, Muscat, Oman.

Objective: Due to increasing life expectancy in our countries, the number of octogenarian patients undergoing an open heart procedure is increasing. In these patients with high comorbidity less invasive procedures could probably improve the postoperative outcome. The aim of this study was to determine the effects of minimal access aortic valve replacement (AVR) in octogenarians on postoperative morbidity and mortality. Methods: Partial upper sternotomy has become the standard approach to isolated aortic valve surgery in patients without any previous cardiac surgery at our institution. Allmost 20 % of the 353 patients who underwent AVR through a partial upper sternotomy between 2007 and 2013 were octogenarians. These 70 patients (16 male, 54 female) had a mean age of 81,8 years (80-95 years). We reviewed retrospectively data on these patients. Results: The patients had a mean logistic Euroscore of 9,1 (0,9-29,2) and a mean left ventricular ejection fraction of 54,7 % (20-70 %). Mean cross clamp time and mean bypass time were 63,3 min (33-149 min) and 108,5 min (52-290 min), respectively. In 3 patients ( 4,3 %) a conversion into full median sternotomy was necessary due to bleeding (n=2) and low cardiac output (n=1). Mean ICU and total hospital stay were 2,8 and 11,7 days, respectively. Postoperative bleeding complications were not observed. Deep sternum infection occured in 2 patients (2,8 %). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. The hospital mortality rate was 5,7 %. Conclusions: AVR through a partial upper sternotomy in octagenarians is a safe and effective technique with less invasivity resulting in satisfying postoperative morbidity and mortality. B>OBJECTIVE:

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