title: Simultaneous aortic and mitral valve replacement in octogenarians: a viable option?
abstract: BACKGROUND
  Few reliable data are available on clinical outcome of octogenarians undergoing simultaneous aortic and mitral valve replacement.
  
  
  METHODS
  We performed a retrospective analysis of 55 patients aged 80 years and over with double valve replacement who were operated on at our institution between 2001 and 2005. Thirty-day mortality and 1-year survival were assessed.
  
  
  RESULTS
  For most of the patients, stenosis was the cause of aortic valve surgery, whereas regurgitation was the cause of mitral valve replacement in the majority of patients. In one third of the patients, cardiac surgery had to be performed on an urgent/emergency basis. A large number of patients had concomitant diagnoses such as atrial fibrillation (73%), coronary artery disease (44%), renal insufficiency (29%), chronic obstructive pulmonary disease (20%), and diabetes mellitus (15%). In total, 16 patients (29%) died during follow-up. Survival rates at 30 days and 1 year were 91% and 71%, respectively. As determined by multivariable logistic regression analysis, Karnofsky performance status (hazard ratio: 0.899 per % increase; 95% confidence interval: 0.811 to 0.996; p = 0.043) and bypass time (hazard ratio: 1.062 per min; 95% confidence interval: 1.006 to 1.120; p = 0.028) were independent predictors of 30-day mortality. Beside these factors, additional independent predictors of 1-year mortality were preoperative stroke and postoperative intestinal failure (p = 0.008 and 0.003, respectively).
  
  
  CONCLUSIONS
  Our data demonstrate that, for selected octogenarians, double valve replacement can be performed with acceptable outcome. A better performance status of the patients at the time of cardiac surgery will probably improve 1-year survival.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North-Rhine Westfalia, University Hospital of Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Ariane
authors.initials: A
authors.lastname: Maleszka
authors.forename: Georg
authors.initials: G
authors.lastname: Kleikamp
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.forename: Maria R G
authors.initials: MR
authors.lastname: Serrano
authors.forename: Reiner
authors.initials: R
authors.lastname: Koerfer
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015150:Echocardiography, Doppler; D005260:Female; D005858:Germany; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome