title: The hidden risks of advancing age and concomitant ischemic heart disease after aortic valve replacement.
abstract: BACKGROUND
  Despite an increasing patient risk profile, in-hospital mortality after aortic valve replacement (AVR) has declined.
  
  
  OBJECTIVE
  Advanced age, concomitant coronary artery bypass grafting (CABG), and increasing comorbidity negatively affect outcomes after AVR and do so particularly in the early months after hospital discharge, where results compare much less favorably with mortality during the first 30 days.
  
  
  METHODS
  The study population consisted of all patients undergoing elective AVR by a single surgeon, with and without CABG, in the decade of 2000-2009. Age, logistic EuroSCORE, diabetes, type of operation, and 30-day and 1-year mortality were recorded.
  
  
  RESULTS
  One hundred ninety-one patients underwent isolated AVR; 133 underwent AVR + CABG. The average age increased by 5.7 years, octogenarians by 50%, logistic EuroSCORE by 18%, and the proportion of diabetics from 4% to 25.5%. Concomitant CABG surgery increased from 36% to 49%. Overall mortality for isolated AVR was zero in the first 30 days and 1.6% in the next 11 months. For AVR and CABG, mortality was 3.75% and 9%, respectively. For octogenarians, mortality was zero and 5.9% for AVR and 4.76% and 14.29% for AVR and CABG at 30 days and in the next 11 months, respectively.
  
  
  CONCLUSIONS
  Thirty-day mortality in all age groups remained low but was much higher in the short term after discharge from hospital, particularly in octogenarians and those with concomitant ischemic heart disease. This should inform the consent process (which traditionally concentrates on in-hospital mortality) and there should be greater awareness of the frailty and particular requirements of the elderly after discharge.
authors: Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors: Annelies E
authors: AE
authors: Mitchell
authors: Ian M
authors: IM
authors: Mitchell
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects; D017558:Elective Surgical Procedures; D004739:England / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000401:mortality; D010351:Patient Discharge; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
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