title: Procedure- and age-specific risk stratification of single aortic valve replacement in elderly patients based on Japan Adult Cardiovascular Surgery Database.
abstract: BACKGROUND
  Successful introduction of trans-catheter aortic valve implantation for selected patients with critical aortic stenosis has raised the question of how to identify appropriate high-risk candidates.
  
  
  RESULTS
  To assess the risk profile of patients undergoing single aortic valve replacement (sAVR), multiple logistic regression analysis was applied for open sAVR (n = 7,883) registered in the Japan Cardiovascular Surgery Database to predict surgical mortality. Three subgroup analyses stratified by age, <70 years (young), 70-79 years (middle), and ≥80 years (elderly), were also performed. Preoperative patient characteristics indicated increased prevalence of several variables in the elderly subgroup including New York Heart Association (NYHA) class III/IV, 3-vessel coronary artery disease (3VCAD), respiratory insufficiency, and stroke. The following factors, however, were decreased in the elderly subgroup: dialysis, poor heart function, reoperation, renal dysfunction, and emergency surgery. Mortality was 3.0% in all sAVR patients and 5.2% in the elderly subgroup. Multivariate analysis in all patients produced 16 variables as operative risks (P<0.05) including respiratory insufficiency, dialysis, NYHA class III/IV, and reoperation. The analysis in the elderly subgroup produced 9 variables with more pronounced relative risk (RR), which included dialysis (RR = 5.4), respiratory insufficiency (RR = 3.3), preoperative arrhythmia (RR = 3.0), 3VCAD (RR = 3.6), and emergency surgery (RR = 23.1).
  
  
  CONCLUSIONS
  sAVR has produced good surgical results in Japan. Procedure- and age-specific analyses have identified a risk profile that is unique to sAVR patients in the elderly population in Japan.
authors: Department of Cardiovascular Surgery, National Hospital Organization, Nagara Medical Center, Gifu, Japan. handa-kcgh @umin.ac.jp
authors: Nobuhiro
authors: N
authors: Handa
authors: Hiroaki
authors: H
authors: Miyata
authors: Noboru
authors: N
authors: Motomura
authors: Takeshi
authors: T
authors: Nishina
authors: Shinichi
authors: S
authors: Takamoto
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009017:Morbidity; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017678:Sex Distribution