One-hundred aortic valve replacements in octogenarians: outcomes and risk factors for early mortality.
OBJECTIVE
Today, ageing of the western population is causing aortic valve surgery to be performed in elderly patients with increasing frequency. The study aim was to evaluate surgical outcome in octogenarian patients undergoing aortic valve replacement (AVR).


METHODS
A total of 100 patients (mean age 82.1 +/- 2.7 years; range: 80-95 years) who underwent AVR over a three-year period was reviewed. Concomitant coronary artery bypass grafting was performed in 34% of cases, and a bioprosthesis was implanted in 80%. The mean logistic EuroSCORE was 13.3%.


RESULTS
Operative mortality was 8.0%. In multivariate analysis, a logistic EuroSCORE > or =13.5% (p = 0.02), cross-clamp time > or =75 min (p = 0.02) and postoperative acute renal failure were predictors for in-hospital mortality. Follow up was 100% complete; the mean follow up period was 10.6 months. At one year after surgery, the actuarial survival rate of those patients who survived surgery was 86.1%. Postoperative dyspnea at one month (p = 0.004) was the only predictor of short-term mortality.


CONCLUSIONS
Age in itself should not contraindicate surgery, and healthcare systems should be prepared to accommodate elderly patients who may require special resources.
Urso
Stefano
S
Policlinica Gipuzkoa, Cirugía Cardiaca, San Sebastian, Spain. stefano_urso@inwind.it
Sadaba
Rafael
R
Greco
Ernesto
E
Pulitani
Ivana
I
Alvarez
Luis
L
Juaristi
Arantxa
A
Goiti
Juan J
JJ
D000369:Aged, 80 and over; D000704:Analysis of Variance; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012107:Research Design; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome