title: Contemporary outcomes of conventional aortic valve replacement in 638 octogenarians: insights from an Italian Regional Cardiac Surgery Registry (RERIC).
abstract: OBJECTIVE
  Few data exist on contemporary outcomes after conventional aortic valve replacement (AVR) in the elderly. Accordingly, we evaluated contemporary outcomes and identified predictors of reduced survival in a large series of octogenarians undergoing AVR.
  
  
  METHODS
  The Regione Emilia Romagna Cardiac Surgery registry (RERIC) database (n = 2 6938) was queried for clinical features, hospital and mid-term outcomes of octogenarians undergoing AVR between 2003 and 2009. Predictors of hospital and mid-term mortality were identified.
  
  
  RESULTS
  The study population consisted of 638 patients. NYHA class III-IV, congestive heart failure, cerebrovascular disease, extra-cardiac arteriopathy, mostly exacerbated patients' clinical profile. Mean log-EuroSCORE was 13.0%. Overall hospital mortality and stroke rates were 4.5% and 1.3%, respectively. Other post-operative complications included renal failure (4.9%), intubation time >48 h (3.4%), complete atrio-ventricular block (4.4%). NYHA III-IV (OR = 2.7; CI 95%:1.2-6.7) and CCS III-IV (OR = 3.1; CI 95%:1.1-9.4) emerged as independent predictors of hospital mortality on multivariate analysis. At 6 years, octogenarians' survival rate was similar to the expected survival of the age- and sex-matched regional population. CCS III-IV (HR = 2.1; CI 95%:1.2-4), preoperative creatinine > 2.1 (HR = 2.8; CI 95%:1.4-5.9), extra-cardiac arteriopathy (HR = 1.5; CI 95%:1.1-2.1) and peripheral neurological dysfunction (HR = 3.8; CI 95%:1.4-10.4) emerged as independent risk factors for decreased 6 years' survival.
  
  
  CONCLUSIONS
  This study, showing that contemporary outcomes after AVR are excellent, may help to improve treatment decision-making in elderly patients with aortic valve disease.
authors.affiliation: Department of Cardiac Surgery, S'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. marco.dieusanio2@unibo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.forename: Daniela
authors.initials: D
authors.lastname: Fortuna
authors.forename: Donald
authors.initials: D
authors.lastname: Cristell
authors.forename: Peppino
authors.initials: P
authors.lastname: Pugliese
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.forename: Mauro
authors.initials: M
authors.lastname: Lamarra
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D012042:Registries; D016896:Treatment Outcome