title: Aortic valve surgery in octogenarians: predictive factors for operative and long-term results.
abstract: OBJECTIVE
  To assess factors influencing operative and long-term outcome in octogenarians undergoing aortic valve surgery (AVR).
  
  
  METHODS
  Records of 220 consecutive octogenarians having AVR between 1992 and 2004 were reviewed, and follow-up obtained (99% complete). Of the group (mean age: 82.8 years; 174 females), 142 patients (65%) were in New York Heart Association (NYHA) class III-IV, 22 (10%) had previous myocardial infarction, 11 (5%) had previous coronary artery bypass grafting (CABG), and 8 (4%) had percutaneous aortic valvuloplasty. There were 44 urgent procedures (20%), and additional CABG was performed in 58 patients (26%).
  
  
  RESULTS
  Operative mortality was 13% (9% for AVR, 24% for AVR+CABG). Among the 29 patients who died, 14 (48%) were operated on urgently (32% mortality for urgent procedures). Causes of hospital death were respiratory insufficiency or infection in 16 patients (16/29=55%), myocardial infarction in 8 (28%), stroke in 2 (7%), sepsis in 2 (7%), and renal failure in 1 (3%). Significant postoperative complications were atrial fibrillation in 48 patients (22%), respiratory insufficiency in 46 (21%), permanent atrio-ventricular bloc in 12 (5%), myocardial infarction in 10 (5%), hemodialysis in 4 (2%), and stroke in 4 (2%). Mean hospital and intensive care unit (ICU) stays were 17.6+/-5.2 and 6.9+/-3.4 days, respectively. Multivariate predictors (p<0.05) of hospital death were urgent procedure, associated CABG, NYHA class IV, and percutaneous aortic valvuloplasty. Age, associated CABG, and urgent procedure were predictors of prolonged ICU stay. Mean follow-up was 58.2 months and actuarial 5-year survival was 73.2+/-6.9%. Age, preoperative myocardial infarction, urgent procedure, and duration of ICU stay were independent predictors of late death. Among 130 patients alive at follow-up, 91% were angina free and 81% in class I-II.
  
  
  CONCLUSIONS
  AVR in octogenarians can be performed with acceptable mortality, although significant morbidity. These results stress the importance of early operation on elderly patients with aortic valve disease, avoiding urgent procedures. Associated coronary artery disease is a harbinger of poor operative outcome. Long-term survival and functional recovery are excellent.
authors.affiliation: Cardiothoracic Surgery Department, University Hospital of Liège, Liège, Belgium. philippe.kolh@chu.ulg.ac.be
authors.forename: Philippe
authors.initials: P
authors.lastname: Kolh
authors.forename: Arnaud
authors.initials: A
authors.lastname: Kerzmann
authors.forename: Charles
authors.initials: C
authors.lastname: Honore
authors.forename: Laetitia
authors.initials: L
authors.lastname: Comte
authors.forename: Raymond
authors.initials: R
authors.lastname: Limet
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome