Are initial valve operations in octogenarians still high-risk in the current era?
OBJECTIVE
The average age of cardiac patients continues to increase. As more octogenarians undergo surgery during the current era, the outcome of valve surgery was investigated to determine the operative risk in these patients.


METHODS
Among 350 patients aged > or = 80 years who had initial surgery between 1998 and 2006, a total of 188 (105 females, 83 males) underwent valve surgery. A prospective analysis was conducted of the collected data.


RESULTS
The median age of patients was 82 years (IQR: 81-84 years), and over half of them presented with severe symptoms (NYHA class III/IV; n = 96), controlled heart failure (n = 108), hypertension (n = 101) and coronary artery disease (n = 108). Concomitant coronary artery bypass grafting (CABG) was performed in 89 cases (47%). Perioperative hemodynamic support with inotropes was common (47%). Hospital death after isolated aortic valve replacement (AVR) (n = 89) and mitral valve replacement (MVR) (n = 10) occurred in four patients (4.5%, median additive EuroSCORE 9.0%) and one patient (10%, median additive EuroSCORE 9.8%), respectively. Concomitant CABG led to a doubling of the operative mortality which, for AVR, declined from 5.4% to 3.8% during the latter half of the study period. The median length of stay was 24 h (IQR 21-44 h) in the intensive care unit, and 10 days (IQR 7-14 days) postoperatively. The risk factors for operative mortality were urgent/emergent surgery (HR 3.27, 95% CI 1.12-9.58, p = 0.03), preoperative gastrointestinal disease (HR 3.15, 95% CI 1.12-8.9, p = 0.03), left ventricular ejection fraction <0.30 (HR 4.37, 95% CI 1.29-14.82, p = 0.02), and ischemic time (HR 1.04, 95% CI 1.004-1.07, p = 0.02).


CONCLUSIONS
Elective isolated AVR can be performed with modest operative risk in octogenarians with good left ventricular systolic function. Additional procedures impose long ischemic times and increase the operative risk, as does MVR. Strategies to minimize the complexity and extent of surgery should benefit these patients.
Ngaage
Dumbor L
DL
Department of Cardiothoracic Surgery, Castle Hill Hospital, Kingston-Upon-Hull, East Yorkshire, UK. dngaage@yahoo.com
Cowen
Michael E
ME
Griffin
Steven
S
Guvendik
Levant
L
Cale
Alexander R
AR
D000369:Aged, 80 and over; D001021:Aortic Valve; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors