title: Impact of ejection fraction on long-term outcome after elective aortic valve replacement in octogenarians with aortic stenosis.
abstract: BACKGROUND
  Aortic stenosis (AS) is increasingly common in the elderly population. A recent invention of transcatheter aortic valve implantation tends to tilt the risk-benefit balance to favor earlier elective intervention for AS. Hence, decision making for elective intervention in octogenarians gradually becomes important. However, the outcome after elective aortic valve replacement (eAVR) has not been evaluated adequately. This study aimed to identify risk factors after eAVR in octogenarians and investigate their influence on long-term outcome.
  
  
  RESULTS
  One hundred and thirty-seven consecutive Japanese octogenarians with AS who underwent eAVR were studied. The mean follow-up period was 35±22 (range, 0-88) months. Long-term overall survival rates after eAVR were 92.0%, 85.2% and 75.5% at 1, 3 and 5 years, respectively. Cox proportional hazards model identified age [hazard ratio (HR) 1.23; 95% confidence interval (CI) 1.07-1.43; P<0.01)] and ejection fraction (EF) <50% (HR 3.38; 95%CI 1.34-8.52; P<0.01) as the risk factors of mortality. Post-eAVR survival rates in octogenarians with an EF ≥50% and <50% were 97.3% and 70.4% at 1 year, 90.1% and 65.3% at 3 years, and 84.3% and 39.2% at 5 years, respectively (P<0.0001).
  
  
  CONCLUSIONS
  Octogenarians with preserved LV systolic function before surgery have favorable long-term survival after eAVR. However, an EF <50% influences the mortality in octogenarian patients. Therefore, eAVR should be considered for octogenarians with AS before the progression of LV impairment.
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan. kshibaya@shi.heart.or.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shibayama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sasaki
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Jun
authors.initials: J
authors.lastname: Umemura
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left