Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: A systematic review and meta-analysis of 40 studies

Aim This study was planned to evaluate the outcome of patients aged >= 80 years undergoing combined conventional aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). Methods This is a systematic review of the literature and meta-analysis of data on patients aged >= 80 years who underwent combined AVR and CABG. Results The literature search yielded 40 observational studies reporting on 8,975 patients aged >= 80 years. Pooled proportion of immediate postoperative mortality was 9.7% (95% CI 8.4-11.1, 40 studies, 8,975 patients). Immediate mortality was 8.2% (95% CI 6.5-10.0) in 15 studies with a mid-date from 2000 to 2007 and 10.8% (95% CI 9.1-12.7) in 25 studies with a mid-date from 1982 to 1999 (P = .043). Postoperative stroke rate was 3.7% (95% CI 2.8-4.8, 12 studies, 2,770 patients), and postoperative implantation of pacemaker was 4.3% (95% CI 2.6-6.5, 5 studies, 535 patients). The mean length of stay in intensive care unit was 5.3 days (95% CI 3.3-7.3, 5 studies, 490 patients), and the mean length of in-hospital stay was 16.9 days (95% CI 12.4-21.4, 5 studies, 424 patients). One-, 3-, 5- and 10-year pooled survival rates after combined AVR and CABG were 83.2%, 72.9%, 60.8%, and 25.7%, respectively. Conclusions Conventional AVR and CABG in patients aged >= 80 years are associated with significant operative mortality and morbidity as well as prolonged in-hospital treatment. However, conventional surgery is associated with remarkably good late survival. This suggests that any alternative treatment modality must prove itself of being enough durable also in the very elderly. (Am Heart J 2012;164:410-418.e1.)