Treatment and outcomes of severe cardiac disease with surgical indication in very old patients

Objective To describe and compare the crude and risk-adjusted survival of a series of octogenarians with symptomatic severe aortic stenosis (SAS) or severe coronary artery disease (SCAD). Methods We reviewed the treatment and outcomes of 130 consecutive patients ≥ 80 years old hospitalized for SAS or SCAD. Results Mean age was 82.8 ± 3.1 years, 52% were women. Of 83 patients with SCAD, 52 were treated by coronary stenting (63%), 12 by coronary artery bypass grafting (15%) and 19 medically (23%). There were no significant differences in baseline characteristics among different treatment groups. When comparing the medically treated group with the intervention group (coronary artery bypass grafting or stenting), the former showed a trend to a worse prognosis (adjusted HR 2.5, 95% CI 0.98–6.6, p = 0.056). Of 47 patients treated with SAS, 33 were treated surgically (70%), 26 by aortic valve replacement (AVR) alone and 7 combined with coronary revascularization. Fourteen patients were treated medically (30%). Patients treated with AVR were younger, presented less frequently a previous MI and had better left ventricular systolic function. Multivariate analysis did not find AVR associated to a better survival (HR 1.1, 95% CI 0.2–5.4). Conclusion Cardiac surgery in octogenarians is more frequently performed in patients with SAS than in patients with SCAD, but survival benefit is probably greater in the latter. A more conservative approach with medical therapy in patients with SAS and coronary stenting in patients with SCAD are alternatives that should be considered.