title: Valve surgery in octogenarians: in-hospital and long-term outcomes.
abstract: BACKGROUND
  Global population aging and greater age-related incidence of ischemic, degenerative and calcific valve disease have led to an increasing number of very elderly patients being referred for valve surgery. However, their preoperative risk factors, and in-hospital and long-term outcomes have not been thoroughly investigated.
  
  
  METHODS
  Three hundred seven consecutive patients 80 years and older (60% female; mean age 83+/-2.4 years) attending three major Italian cardiac centres to undergo valve surgery were evaluated. Seventy-nine patients underwent mitral valve surgery (isolated n=30, combined n=49) and 228 underwent aortic valve surgery (isolated n=134, combined n=94).
  
  
  RESULTS
  The most frequent in-hospital complications were atrial arrhythmias, need for inotropic support for more than 48 h, renal insufficiency, congestive heart failure, respiratory failure, and stroke or transient ischemic attack. The in-hospital mortality rate was 9.7% (30 of 307). Multivariate logistic regression identified the following clinical variables as predictors of in-hospital death: New York Heart Association functional class IV, diabetes, hypertension, renal insufficiency at presentation, rheumatic etiology and left ventricular ejection fraction of less than 45%. Late mortality occurred in 45 of 277 patients (16.2%), but there was a substantial improvement in the New York Heart Association functional class of the 232 long-term survivors (from 3.0+/-0.7 to 1.7+/-0.6; P<0.0001).
  
  
  CONCLUSIONS
  Surgery seems to be an effective therapeutic option for selected symptomatic octogenarians with valve disease, associated with good long-term survival and an improved functional class. Operative mortality is related more to patients' preoperative clinical status and increased comorbidity than the type of surgery per se.
authors.affiliation: Institute of Clinical Physiology, National Research Council of Italy, Lecce Section. ebossone@hotmail.com
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Benedetto
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
authors.forename: Giannignazio Luigi
authors.initials: GL
authors.lastname: Carbone
authors.forename: Antonello
authors.initials: A
authors.lastname: Panza
authors.forename: Silvia
authors.initials: S
authors.lastname: Cirri
authors.forename: Andrea
authors.initials: A
authors.lastname: Ballotta
authors.forename: Stefano
authors.initials: S
authors.lastname: Messina
authors.forename: Saverio
authors.initials: S
authors.lastname: Rega
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.forename: Jianming
authors.initials: J
authors.lastname: Fang
authors.forename: Paolo
authors.initials: P
authors.lastname: Righini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Distante
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery