Long-term survival, autonomy, and quality of life of elderly patients undergoing aortic valve replacement.
OBJECTIVE
We reviewed the long-term survival, autonomy, and quality of life (QoL) of elderly patients undergoing aortic valve replacement (AVR).


METHODS
Records of patients ≥75 years old that underwent AVR from 2002 to 2006 were retrospectively analyzed. Functional status was classified with Barthel Index (BI). QoL was presumed as the self-perception of well-being after AVR. Independent predictors of mortality were identified using the Cox proportional hazards model.


RESULTS
We included 114 patients, with a mean age of 78.5 ± 2.5 years. Seventy (59.8%) patients were females. Mean additive and logistic EuroSCORE were 7 ± 2 and 9 ± 7, respectively. Follow-up on vital status was achieved for 113 (99.1%) patients after a mean period of 47.2 ± 23.4 months. Twenty-seven (23.7%) patients died (including three operative deaths). Survival up to one, three, and five years of follow-up was 94.4%, 86.7%, and 76.1%, respectively. Multivariate analysis showed that pulmonary hypertension and diabetes were independent predictors of all-cause mortality. Information on BI score and QoL was obtained for 77 (89.5%) and patients. Among those, 69 (89.6%) were autonomous according to BI and 72 (93.5%) considered having had an improvement in QoL.


CONCLUSIONS
Patients ≥75 years old undergoing AVR presented good medium-term survival. Predictors of an adverse outcome were significant pulmonary hypertension and diabetes. At follow-up, most achieved improvement of QoL and remained autonomous. These results stress that excellent long-term outcomes with AVR can be achieved in appropriately selected elderly patients.
Cardiology Department, Hospital de São João, Porto, Portugal. silviamartaoliveira@yahoo.co.uk
Sílvia Marta
SM
Oliveira
Ana Sofia
AS
Correia
Mariana
M
Paiva
Alexandra
A
Gonçalves
Marta
M
Pereira
Elisabete
E
Alves
Paula
P
Dias
Rui
R
Almeida
Armando
A
Abreu
Paulo
P
Pinho
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D026684:Personal Autonomy; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome