title: Risk factors for late valve-related mortality after aortic valve replacement in elderly patients.
abstract: OBJECTIVE
  Few recent studies have examined the long-term outcomes after aortic valve replacement (AVR), and independent predictors for long-term survival and valve-related mortality have not been elucidated.
  
  
  METHODS
  From January 1993 to December 2009, 132 elderly patients (≥70 years old) with aortic stenosis underwent AVR in our hospital. The patients comprised 61 men and71 women with a mean age of 76.1 ± 3.7 years. Patients with acute or old myocardial infarction, mitral valve disease, and re-do surgery were not included in this study. Risk factors for late valve-related mortality were examined.
  
  
  RESULTS
  The 5-year freedom from valve-related mortality rate was 89.6%. The following significant independent risk factors for late valve-related mortality were identified:increase in the preoperative left ventricular mass index (hazard ratio, 1.10 [per 10 g/m(2)];p = 0.040); lack of sinus rhythm (hazard ratio, 7.11; p = 0.005); peak transvalvular pressure gradient of <60 mmHg (hazard ratio, 7.48; p = 0.008).
  
  
  CONCLUSIONS
  In the elderly, AVR should be performed at an early stage of aortic stenosis, before an increase in the left ventricular mass index has occured, and while the heart rhythm is in sinus rhythm and the peak transvalvular pressure gradient is high.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Hosono
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Hirai
authors.forename: Masanori
authors.initials: M
authors.lastname: Sakaguchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakahira
authors.forename: Akimasa
authors.initials: A
authors.lastname: Morisaki
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
mesh_terms: D000367:Age Factors; D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome