Outcomes of Aortic Valve Replacement Performed by Residents in Octogenarians1

BackgroundAortic 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.MethodsA 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.ResultsAll 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.ConclusionsSupervised residents can safely perform AVR on octogenarian patients and achieve good outcomes.