Aortic valve replacement in geriatric patients: determinants of in-hospital mortality.
BACKGROUND
Aortic valve replacement is a common procedure in elderly patients. There has been a great deal of controversy about the risks associated with early mortality. Uncertainty of the risk associated with a small valve continues to remain controversial. This study was designed to identify the risk factors influencing early mortality and establish an accurate model for the prediction of in-hospital mortality.


METHODS
One hundred eighty septuagenarians and octogenarians (58% women; mean age, 76 +/- 4.7 years) underwent primary isolated aortic valve replacement between 1986 and 1997. There was an overall mortality of 16.7% (n = 180). Patients with a body surface area less than 1.8 m2 had an in-hospital mortality of 23.2% (n = 95) compared with 8.1% (n = 74; p = 0.009) for patients with a body surface area of 1.8 m2 or more. Patients with a cardiopulmonary bypass time of less than 100 minutes experienced an early mortality of 8.9% (n = 56) compared with a 10.2% (n = 59) early mortality for patients on bypass time between 100 and 124 minutes and a 29.6% (n = 64) early mortality in patients with a pump time longer than 124 minutes (p = 0.040).


RESULTS
Multivariate logistic regression analysis identified small body surface area and long cardiopulmonary bypass time as independent risk factors. A higher mortality was seen in female patients and patients receiving smaller valves. However, there was a strong correlation between small body surface area, small valve size, and female gender.


CONCLUSIONS
Small body surface area and long cardiopulmonary bypass time are two independent risk factors in early mortality for elderly patients undergoing primary isolated aortic valve replacement. The use of small valves does not influence early mortality.
Division of Cardiothoracic Surgery, Newark Beth Israel Medical Center, New Jersey, USA. lbloomst@astro.temple.edu
L Z
LZ
Bloomstein
I
I
Gielchinsky
A D
AD
Bernstein
V
V
Parsonnet
C
C
Saunders
R
R
Karanam
B
B
Graves
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001830:Body Surface Area; D002315:Cardiopulmonary Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D011474:Prosthesis Design; D012307:Risk Factors