title: Current hospital mortality of aortic valve replacement in octogenarians.
abstract: OBJECTIVE
  The increasing incidence of cardiovascular disease with age, coupled to a constant extension of life expectancy in industrialized countries, is leading to an ever-increasing number of elderly patients being referred for aortic valve replacement (AVR). In light of advances in surgical technology and cardiac protection, the operative mortality and risk factors have been updated in order to specify surgical indications.
  
  
  METHODS
  Between January 2000 and December 2004, a total of 442 patients (203 males, 239 females) aged > or =80 years (mean age 82.7 +/- 2.3 years) underwent AVR at the authors' institution. Surgery was either isolated (n = 344) or associated with coronary revascularization (n = 86), mitral valvuloplasty (n = 5) or aortic surgery (n = 7). Seventeen patients had undergone previous cardiac surgery. The EuroScore was calculated for each patient.
  
  
  RESULTS
  Overall operative mortality was 7.5% (n = 33). Independent predictive factors of mortality were: aortic insufficiency (30%, p <0.004), NYHA class IV (20.5%, p < 0.001), left and right heart failure (11.5% and 19.4%, p <0.02), chronic renal insufficiency (18.5%, p <0.04), emergency (37.5%, p <0.001, OR = 4.7), left ventricular ejection fraction (21.1%, p <0.004, OR = 0.9), and redo surgery (35.3%, p <0.001, OR = 6). Mortality was also increased in case of associated coronary revascularization (11.6%), mitral or tricuspid surgery (20%) and ascending aorta procedure (25%).
  
  
  CONCLUSIONS
  Patient functional improvement achieved after valve replacement at the cost of a rather low operative mortality justifies considering octogenarians for surgery. However, decisions should be taken on an individual basis. An earlier referral to surgery before the onset of altered cardiac function could lead to further reductions in hospital mortality.
authors.affiliation: Thoracic and Cardiovascular Surgery Department, University Hospital, Rennes, France. thierry.langanay@chu-rennes.fr
authors.forename: Thierry
authors.initials: T
authors.lastname: Langanay
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ocampo
authors.forename: Marco
authors.initials: M
authors.lastname: Vola
authors.forename: Arnaud
authors.initials: A
authors.lastname: Tauran
authors.forename: Bertrand
authors.initials: B
authors.lastname: De La Tour
authors.forename: Thierry
authors.initials: T
authors.lastname: Derieux
authors.forename: Anne
authors.initials: A
authors.lastname: Ingels
authors.forename: Hervé
authors.initials: H
authors.lastname: Corbineau
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
mesh_terms: D000369:Aged, 80 and over; D000704:Analysis of Variance; D001022:Aortic Valve Insufficiency / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005602:France / Q000453:epidemiology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012086:Reoperation / Q000401:mortality; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016896:Treatment Outcome