The stentless freestyle bioprosthesis: impact of age over 80 years on quality of life, perioperative, and mid-term outcome.
BACKGROUND
The steadily increasing life expectancy of the population in the Western World, together with the progress in noninvasive diagnostic methods and operating techniques lead to an increase in aortic valve surgery in elderly people.


OBJECTIVE
Is there an increased risk of adverse perioperative and mid-term outcome for octogenarians and do they benefit from aortic valve replacement (AVR) with stentless bioprostheses?


METHODS
Between 1996 and 2002, 503 patients older than 60 years underwent AVR with a stentless Freestyle bioprosthesis. Seventy-six of them were older than 80 years. The risk of operative mortality, perioperative complications, valve-related morbidity for octogenarians was determined by multivariate logistic regression.


RESULTS
In general, risk-adjusted analyses did not reveal an increased risk of operative mortality (p = 0.4), postoperative atrial fibrillation (p = 0.2), prolonged ventilation (p = 0.5), prolonged stay in the intensive care unit (p = 0.3), or mid-term valve-related morbidity as prosthetic valve endocarditis (p = 0.2), reoperation (p = 0.4), bleeding events (p = 0.1), and stroke (p = 0.8) for octogenarians. Continuously increasing age was an independent risk factor for postoperative neurological complications (OR = 1.8 per 10 years, p = 0.04). Quality of life was equal to or better than the general population of the same age. Median survival time of octogenarians was 5.2 +/- 0.5 years.


CONCLUSIONS
Except for postoperative neurological complications, octogenarians receiving stentless bioprostheses had no increased risk of adverse perioperative and mid-term outcome in comparison to younger patients. As quality of life and life expectancy after AVR with stentless valves were equal to the general population, AVR with stentless bioprostheses should not be withheld from octogenarians.
Ennker
Jürgen
J
Heart Institute Lahr/Baden, Lahr, Germany.
Dalladaku
Fatmir
F
Rosendahl
Ulrich
U
Ennker
Ina Carolin
IC
Mauser
Manfred
M
Florath
Ines
I
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D008017:Life Expectancy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011474:Prosthesis Design / Q000295:instrumentation; D011788:Quality of Life; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome