Navigation Links
Repeat sternotomy for aortic valve replacement safe option for octogenarian patients

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
American Association for Thoracic Surgery

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:
(Date:6/24/2016)... ... June 24, 2016 , ... The Pulmonary Hypertension Association (PHA) ... will receive two significant new grants to support its work to advance research ... anniversary by recognizing patients, medical professionals and scientists for their work in fighting ...
(Date:6/24/2016)... ... June 24, 2016 , ... Dr. Amanda Cheng, ... treatment. Dr. Cheng has extensive experience with all areas of orthodontics, including robotic ... osteogenic orthodontics. , Micro-osteoperforation is a revolutionary adjunct to orthodontic treatment. It ...
(Date:6/24/2016)... ... ... makers of Topricin and MyPainAway Pain Relief Products, join The ‘Business for a Fair Minimum ... by 2020 and then adjusting it yearly to increase at the same rate as the ... wage floor does not erode again, and make future increases more predictable. , The company ...
(Date:6/24/2016)... ... June 24, 2016 , ... EB Medicine presented its first-ever ... Medicine conference in Ponte Vedra Beach, FL. The awards honor the outstanding work ... Practice and Pediatric Emergency Medicine Practice. , “With this award, we recognize ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... ... client, The Grove Investment Group (TGIG), has initiated cultivation and processing operations at ... Las Vegas and Pahrump, Nevada. , Puradigm is the manufacturer of a complete ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... 23, 2016 Research and Markets ... Market by Type (Organic Chemical (Sugar, Petrochemical, Glycerin), Inorganic ... Coating, Parenteral) - Global Forecast to 2021" report ... The global pharmaceutical excipients market is projected to ... of 6.1% in the forecast period 2016 to 2021. ...
(Date:6/23/2016)... , June 23, 2016 Roche (SIX: RO, ... clearance for its Elecsys BRAHMS PCT (procalcitonin) assay as ... or septic shock. With this clearance, Roche is the ... fully integrated solution for sepsis risk assessment and management. ... bacterial infection and PCT levels in blood can aid ...
(Date:6/23/2016)... Capricor Therapeutics, Inc. ... company focused on the discovery, development and commercialization ... in its ongoing randomized HOPE-Duchenne clinical trial (Halt ... its 24-patient target. Capricor expects the trial to ... 2016, and to report top line data from ...
Breaking Medicine Technology: