Navigation Links
Repeat sternotomy for aortic valve replacement safe option for octogenarian patients
Date:3/26/2014

Beverly, MA, March 26, 2014 Surgical aortic valve replacement generally improves patients' symptoms and prolongs survival. However, the perceived risk of surgical aortic valve replacement in patients over 80 may result in surgery being denied or a recommendation for alternative therapy. Investigators at the Mayo Clinic challenge the way these patients have been managed. They report that repeat sternotomy in patients over 80 who have previously had coronary bypass graft surgery can be done with low risk. Their findings are published in the Journal of Thoracic and Cardiovascular Surgery, an official publication of the American Association for Thoracic Surgery.

"Our experience is that the prevalence of operative morbidity and mortality is the same as for primary sternotomy and surgical aortic valve replacement," says lead investigator Kevin L. Greason, MD, Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN. "Based on the available evidence, there is no compelling argument to abandon the technique in favor of transcatheter replacement. Repeat sternotomy for surgical aortic valve replacement is a safe option."

The outcome of non-surgical management in elderly patients with symptomatic severe aortic valve stenosis is disappointing. A prior study demonstrated that nearly half of patients in their 80s who were treated with aggressive medical therapy died within a year. There is general agreement that such patients benefit from surgical aortic valve replacement. Earlier studies have shown that this appears to be as safe as transcatheter replacement and that there was no difference in 30-day operative mortality rates in patients who received transcatheter replacement versus surgical replacement. But little is known about the potential risks of repeat surgery.

To assess these risks, investigators reviewed the records of 629 octogenarian patients who had narrowing of the aortic valve in the heart and who had undergone sternotomy between January 1993 and December 2011. Of these, 111 patients (17.6%) had received a previous coronary artery bypass graft and therefore a repeat sternotomy was required. All patients had their surgery at the Mayo Clinic.

Those patients who underwent a repeat sternotomy had more pre-existing conditions and a higher predicted risk of death than those undergoing primary sternotomy. Despite the higher risk, the results in the repeat sternotomy group were similar to those in patients who received primary sternotomy. The cardiopulmonary bypass time was longer in the repeat sternotomy group compared with the primary sternotomy group, but there was no difference in the aortic crossclamp time between the two groups. Stroke occurred in three patients (2.7%) after repeat sternotomy and in 10 patients (1.9%) after primary sternotomy. Rates of myocardial infarction, renal failure, and reoperation for bleeding were similar between the two groups. Seven patients (6.4%) died after repeat sternotomy and 19 patients (3.7%) died after primary sternotomy. There were no deaths in the seven patients who received either a third or fourth sternotomy.

"The main finding in our study is that repeat sternotomy is not a predictor of operative mortality for isolated surgical aortic valve replacement," says Dr. Greason. "Repeat sternotomy and surgical aortic valve replacement can be done with low risk in patients in their 80s." He observes however that "These patients were operated on at a high-volume center and were selected for operation by a group of surgeons well versed in complex reoperative cardiac surgical procedures, so these results may not be reproducible at centers without the same degree of experience. An option may be to refer these patients to a specialist center."


'/>"/>

Contact: Nicole Baritot
press@aats.org
978-299-4520
American Association for Thoracic Surgery
Source:Eurekalert

Related medicine news :

1. Omega-3 Supplements No Help Against Repeat Heart Trouble: Review
2. Black stroke survivors have higher blood pressure, increased risk of repeat stroke
3. Use of regional PACS network associated with lower repeat rates, costs and less radiation exposure
4. Repeated exposure to traumatic images may be harmful to health
5. New Device May Reduce Repeat Breast Cancer Surgeries
6. Study: Repeated surgeries appear to extend life of patients with deadliest of brain cancers
7. Study: New tool helps doctors predict heart attack patients at risk for repeat hospitalization
8. Could Cholesterol Treatment Fight Repeat Heart Attack?
9. Study suggests repeat testing common among medicare beneficiaries
10. Costly, Repeat Medical Testing Common for Medicare Patients: Study
11. Breast cancer risk estimates increased with repeated prior ct and nuclear imaging
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... October 13, 2017 , ... ... in the greater Dallas, Miami, and Raleigh regions, is organizing an extended charity ... a rare and deadly chromosome abnormality. , After struggling since birth with several ...
(Date:10/13/2017)... ... October 13, 2017 , ... The American Board of Family Medicine's ... President and Chief Executive Officer, succeeding Dr. James C. Puffer upon his retirement. Dr. ... 2018 until Dr. Puffer’s retirement at the end of 2018. Upon assuming the role ...
(Date:10/13/2017)... , ... October 13, 2017 , ... Lori R. Somekh, ... member of ElderCounsel, a national organization of elder law and special needs planning attorneys. ... and rules. It also provides a forum to network with elder law attorneys nationwide,” ...
(Date:10/13/2017)... ... 2017 , ... Ellevate Network, the leading network for professional women, brought together ... equality at their inaugural Summit in New York City in June. The event was ... of over 3 million. To watch the Mobilize Women video, click here . ...
(Date:10/13/2017)... ... October 13, 2017 , ... Coveros, ... Development, has been awarded a contract by the Center for Medicare and Medicaid ... to accelerate the enterprise use of Agile methodologies in a consistent and high ...
Breaking Medicine News(10 mins):
(Date:10/10/2017)... , Oct. 10, 2017   West Pharmaceutical Services, ... solutions for injectable drug administration, today shared the results ... Adapter for improving the intradermal administration of polio vaccines. ... Vaccination Summit in May 2017 by Dr. Ondrej ... Department, World Health Organization (WHO), and recently published in ...
(Date:10/4/2017)... OBP Medical , a leading ... today announced regulatory approval from Brazil,s ... Nacional de Vigilância Sanitária (ANVISA)) to market ... with integrated LED light source and smoke evacuation ... of a tissue pocket or cavity during surgical ...
(Date:10/2/2017)... 2, 2017 The Rebound mobile app is poised ... reverse the tide of prescription drug addiction. The app empowers ... intake and stepping down their dosage in a safe, controlled ... December 2017; the first 100,000 people to sign up will ... http://www.rebound-solution.com/ ...
Breaking Medicine Technology: