Outcomes of Aortic Valve Replacement Performed by Residents in Octogenarians

Background: Aortic valve replacement (AVR) traditionally carries a significant risk in elderly patients. We evaluated the outcomes of AVR in octogenarian patients in the context of surgical education.

Methods: A retrospective review of all AVR operations (n=23) performed by residents at a single academic institution between May 1992 and May 2007 on patients who were >/=80 y old.

Results: All patients were men (mean age, 83+/-2.5 y). The predominant valve disease was aortic stenosis. Comorbidities included coronary artery disease (n=15), New York Heart Association class III/IV congestive heart failure (n=15), hypertension (n=17), diabetes (n=5), chronic obstructive pulmonary disease (n=5), peripheral vascular disease (n=6), and cerebrovascular disease (n=3). Major postoperative morbidity included cerebrovascular accident (n=1), mediastinitis (n=1), reoperation for bleeding (n=1), and respiratory failure (n=3; 2 required a tracheostomy). There were no operative deaths. The mean length of total hospital stay (to home discharge) after AVR was 36+/-45 d, of which 19+/-14 d were spent in an acute surgical care unit. Follow-up was complete; the 1-, 3-, and 5-y survival rates were 96%, 86%, and 55%, respectively.

Conclusions: Supervised residents can safely perform AVR on octogenarian patients and achieve good outcomes.