Risk Factors Of Early And Long - Term Prognosis In Elderly Patients With Heart Valve Surgery And Coronary Artery Bypass Grafting

Objectives:Although the number of elderly patients undergoing heart valve surgery combined with coronary artery bypass grafting (CABG) is increasing, risk factors for the early prognosis of these patients remain to be elucidated. Our aim is to analyze the risk factors for in-hospital mortality and early major post-operation complications in these patients.Methods:Between February 2002 and September 2014,540 patients aged over 65 years undergoing heart valve surgery combined with CABG in Fuwai hospital were retrospectively studied. Early prognoses were composed of in-hospital mortality and early major post-operation complications; the latter was defined as a composite of re-exploration, prolonged ventilation>48h, low cardiac output, requirement for dialysis, malignant arrhythmia, stoke and mediastinitis. Multi-variable logistic regression analyses were performed to explore risk factors associated with the early prognosis of these patients.Results:Among them,365 cases (67.6%) were male and 175 (32.4%)were female, the mean weight was 65.8±10.1 kg. Overall in-hospital mortality was 4.3%. Multi-variable logistic regression analyses revealed that chronic obstructive pulmonary disease(COPD)[P=0.005, odds ratio(OR)=5.598,95% confidence interval (CI) 1.703-18.401], cardiopulmonary bypass(CPB) time(P<0.001,OR=1.011,95%CIl.005-1.017),re-exploration (P<0.001,OR=15.813,95%CI 5.415-46.178), and post-operation malignant arrhythmia(P=0.014, OR=4.900,95%CI 1.374-17.470) as independent risk factors of in-hospital mortality. The rate of early major post-operation complications was 23.0%. Multi-variable logistic regression analyses revealed that female (P<0.001,OR=2.445,95%CI 1.493-4.002), CPB time (P<0.001, OR=1.015,95%CI 1.011-1.019), left ventricular eject fraction (P=0.049, OR=0.976,95%CI 0.953-1.000), and last creatine level (P=0.014,OR=4.900,95%CI 1.374-17.470) as independent risk factors of early major post-operation complications.Conclusions:The present research demonstrates that female, COPD, left ventricular eject fraction, last creatine level, CPB time, re-exploration and malignant arrhythmia as risk factors for the early prognosis in patients aged over 65 years undergoing combined heart valve surgery and CABG.Objectives:Our aim is to analyze the risk factors for the long-term prognosis in elderly patients undergoing aortic valve replacement (AVR) combined with coronary artery bypass grafting (CABG)Methods:Between February 2004 and September 2014,225 patients aged over 65 years undergoing AVR combined with CABG in our institute were enrolled. The study population was followed up in the post-operative period until the commencement of our study in May 2015. Follow-up involved review of outpatient or inpatient medical records and structured telephone interviews to patients or relatives. Major adverse cardiovascular events (MACE) were used as primary endpoints of the long-term follow-up. MACE was defined as a composite of late cardiac death, repeat revascularization, stroke, pacemaker implantation, New York Heart Association (NYHA) class III-IV and angina recurrence. Cox proportional hazards model were performed to determine risk factors associated with the long-term prognosis of these patients.Results:Among them,174 cases (77.3%)were male and 51 (22.7%) were female, the mean weight was 68.3±8.9kg. The follow-up rate was 91.1%, the average follow-up period was 41.2 months,6 patients (2.7%) were died from cardiac death during the follow-up period, the major adverse cardiac events were cardiac dysfunction or return of angina (8.9%). Freedom from MACE at 1-,5-and 10-year were 92%,77%, and 40%, respectively. The Cox proportional hazards model revealed that hyperlipidemia [P=0.025, hazard ratio (HR)=2.535,95% confidence interval (CI) 1.126-5.707], smoking (P=0.009, HR=3.414,95%CI 1.358-8.582) and the history of percutaneous coronary intervention (P=0.013, HR=3.562,95%CI1.310-9.686) as independent risk factors of the late prognosis of patients.Conclusions:The present research demonstrates that elderly patients undergoing AVR combined with CABG are safe and effective. Hyperlipidemia, smoking and the history of percutaneous coronary intervention were independent predictors for long-term outcomes.