title: Aortic valve replacement in octogenarians: outcome and predictors of complications.
abstract: BACKGROUND
  We aimed to evaluate the outcome in octogenarians after aortic valve replacement (AVR) and to determine the perioperative parameters that were predictive of a complicated postoperative course.
  
  
  METHODS
  The study population included 304 patients (65% male) aged 82.7 ± 3.5 years who underwent AVR alone (63%), in combination with coronary artery bypass grafting (28%) or with other procedures (9%), between 1998 and 1/2008. Most patients suffered from combined valve disease.
  
  
  RESULTS
  Mechanical valves were implanted in 50% of the patients. The in-hospital mortality was 5.8%. The stay in the intensive care unit was 2.3 ± 0.5 days and in hospital 15.3 ± 2.6 days. After multivariate analysis we were able to identify some predictors for in-hospital mortality, such as preoperative cardiogenic shock (p<0.02), ejection fraction <0.3 (p<0.03), diameter of prosthesis <21 mm (p<0.05), and redo surgery. The most important predictors for postoperative complications after AVR were preoperative renal failure, additional surgical procedures (i.e. coronary artery bypass, mitral valve) and prolonged aortic crossclamping (all p<0.05).
  
  
  CONCLUSIONS
  The outcome after AVR in octogenarians is satisfactory; the operative risk is acceptable and might even be reduced with an individual approach to perioperative management in high-risk patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital, Düsseldorf, Germany. jens-litmathe@t-online.de
authors.forename: Jens
authors.initials: J
authors.lastname: Litmathe
authors.forename: Peter
authors.initials: P
authors.lastname: Feindt
authors.forename: Muhamed
authors.initials: M
authors.lastname: Kurt
authors.forename: Emmeran
authors.initials: E
authors.lastname: Gams
authors.forename: Udo
authors.initials: U
authors.lastname: Boeken
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome