Aortic valve replacement in octogenarians: identification of high-risk patients.
OBJECTIVE
This study identifies high-risk octogenarians for surgical aortic valve replacement (AVR) because with the current advances in transcatheter valve therapy, a definition of patient selection criteria is essential.


METHODS
Between 1996 and 2006, 493 consecutive octogenarians with symptomatic aortic stenosis underwent AVR with and without (51%) concomitant coronary artery bypass grafting (CABG). To identify high-risk patient groups, risk factors of 6-month mortality were determined using multivariable logistic regression.


RESULTS
The 30-day mortality rate was 8.4% and it increased up to 15.2% until 6 months after AVR. Independent risk factors of 6-month mortality were patients older than 84 years (odds ratio (OR): 2.2 (1.29-3.61)), left ventricular ejection fraction <60% (OR: 2.5 (1.35-4.61)), body mass index (BMI) <24 (OR: 2.0 (1.22-3.36)), creatinine (OR: 1.6 (1.04-2.53)) and blood glucose (OR: 1.01 (1.001-1.009)). High-risk groups were patients older than 84 years with an ejection fraction <60% (6-month mortality 28%) and patients younger than 84 years with an ejection fraction <60% and a BMI <24 (6-month mortality 23.2%). These high-risk groups comprised 37% of the patient population. After isolated AVR, the 30-day mortality and survival at 1 and 5 years was 11.6%, 69% and 35% in this high-risk group, respectively. In octogenarians with an STS score >10 and an EuroScore >20, the 30-day mortality and survival at 1 year was 10.5% and 80%, 11.6% and 77%, respectively.


CONCLUSIONS
In most octogenarians, AVR is a safe and beneficial procedure. In high-risk octogenarians, identified by STS score >10, EuroScore >20 and by simple three risk factors (age >84 years, ejection fraction <60% and BMI <24), the mortality after surgical AVR was no different from the currently reported outcome after transcatheter AVI.
Florath
Ines
I
Heart Institute Lahr/Baden, Hohbergweg 2, D-77933 Lahr, Germany. ines.florath@mediclin.de
Albert
Alexander
A
Boening
Andreas
A
Ennker
Ina Carolin
IC
Ennker
Juergen
J
D000367:Age Factors; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D003404:Creatinine