title: Surgical aortic valve replacement in very elderly patients aged 80 years and over: evaluation of early clinical outcomes.
abstract: BACKGROUND
  An increasing number of very elderly patients aged ≥80 years will require aortic valve replacement (AVR) for severe aortic stenosis (AS). Many are classified as high-risk surgical candidates. Transcatheter aortic valve implantation (TAVI) has been proposed as an alternative to surgical AVR (SAVR) for high-risk patients. We evaluated early clinical outcomes of very elderly patients undergoing SAVR to optimise TAVI candidate selection.
  
  
  METHODS
  We conducted a retrospective case review of 132 consecutive patients aged ≥80 years undergoing isolated SAVR (49 patients) or combined SAVR/CABG (83 patients) during February 2002-January 2010 at a single tertiary referral hospital. Risk for cardiac surgery was calculated using the logistic EuroSCORE (ES(log)). Mortality and morbidity data were collected for the 30-day postoperative period.
  
  
  RESULTS
  Thirty-day mortality rate was 8.3% for patients undergoing SAVR (6.1% for isolated SAVR and 9.6% for SAVR/CABG). Permanent stroke occurred in 3.8% and renal insufficiency in 7.6% of the cohort. Thirty-five percent of patients had left ventricular ejection fraction <50%, 67% had advanced symptoms (NYHA class III or IV), and 42% of patients were stratified as high-risk (ES(log)≥20%).
  
  
  CONCLUSIONS
  SAVR can be performed in very elderly patients with acceptable operative morbidity and mortality. The outcomes at our institution are comparable to contemporary SAVR and TAVI outcomes.
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, Australia. Electronic address: ed.kk.ho@gmail.com.
authors.forename: Edwin
authors.initials: E
authors.lastname: Ho
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Manu N
authors.initials: MN
authors.lastname: Mathur
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Brady
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Marshman
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Brereton
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Ross
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Ravinay
authors.initials: R
authors.lastname: Bhindi
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hansen
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D051437:Renal Insufficiency / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors
keywords: Aortic stenosis; Aortic valve replacement; Elderly; Octogenarians; Transcatheter aortic valve implantation