Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long term results.
OBJECTIVE
In the last decade, cardiac surgery in octogenarians is becoming a routinely performed procedure in our Western countries. The functional benefit of this surgery had already been proved. The aim of this study was to evaluate operative mortality, to identify pre- and post-operative risk factors of early and late mortality, to assess the Euroscore count in this high-risk group of patient and to evaluate late results of this surgery.


METHODS
We reviewed 215 consecutive patients with a mean age of 83+/-2 years having undergone valvular surgery. There were 127 female patients (57.1%) and 88 males (42.9%). One hundred and fifty-nine patients (74%) underwent aortic valve replacement 42 (19.5%) mitral surgery and 14 (6.5%) double valve surgery. There were 32 (14.9%) re-operative cases. Twenty-seven patients (12.6%) were operated on in emergency. There were 32 re-operations (14%). The EuroSCORE was used to assess predicted operative risk. Mean Euroscore additive count was 9.5+/-2.3 and mean logistic Euroscore was 15.1%.


RESULTS
Operative mortality was 8.8% (19 patients). Left ventricular dysfunction was the only pre-operative significant risk factors of mortality (P=0.05). Low cardiac output (P<0.001), gastrointestinal complications (P=0.03) and surgical reexploration (P=0.001) were significant risk factors of mortality. Mean survival was 84% after one year and 56% after 5 years.


CONCLUSIONS
Valvular surgery in octogenarians is a safe and low risk procedure compared to functional benefit and long-term survival. Our data how that logistic Euroscore overestimates the mortality in this high-risk group of patients.
Collart
Frédéric
F
Service de Chirurgie cardiaque, Hopital de la Timone, 246 rue St Pierre, 13385 Marseille cx 05, France. fcollart@univ-aix.fr
Feier
Horea
H
Kerbaul
Francois
F
Mouly-Bandini
Annick
A
Riberi
Alberto
A
Mesana
Thierry G
TG
Metras
Dominique
D
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D002303:Cardiac Output, Low / Q000150:complications / Q000401:mortality / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013223:Statistics as Topic; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality / Q000601:surgery