title: Age alone should not preclude surgery: contemporary outcomes after aortic valve replacement in nonagenarians.
abstract: OBJECTIVE
  Advanced age plays a major role in surgical risk algorithms; however, the outcomes data for the very elderly are lacking. We, therefore, evaluated the outcomes after surgical aortic valve replacement (SAVR) in nonagenarians (age, >90 years) at our institution during an 11-year period.
  
  
  METHODS
  The demographics, procedural details, and in-hospital outcomes were retrospectively analyzed for 119 nonagenarians with symptomatic, severe aortic stenosis who had undergone SAVR or SAVR plus concomitant surgery from 2001 to 2012. The mean follow-up period was 915±832 days.
  
  
  RESULTS
  The average age was 91.7±1.9 years (range, 90-98), and the mean Society of Thoracic Surgeons score was 8.9±5.7. The mean aortic valve gradient was 45±16 mm Hg, mean aortic valve area was 0.66±0.2 cm2, and mean ejection fraction was 49.8%±11.8%; 47% underwent isolated SAVR. The average length of stay was longer than expected; however, the rates of prolonged ventilation (16.8%), new atrial fibrillation (43.7%), stroke (0.8%), and renal failure (5.9%) were acceptable. Three patients (2.5%) required reoperation for bleeding. Overall, the 30-day and 1-year mortality was 7.6% and 21.0%, respectively. The multivariate predictors of mortality at 1 year included previous myocardial infarction (hazard ratio, 2.79; 95% confidence interval, 1.21-6.45; P=.016), obstructive lung disease (hazard ratio, 3.90; 95% confidence interval, 1.66-9.15; P=.025), and diabetes (hazard ratio, 2.77; 95% confidence interval, 1.08-7.07; P=.033). The observed in-hospital mortality was lower than expected (observed/expected, 0.85).
  
  
  CONCLUSIONS
  Excellent procedural and long-term outcomes can be achieved in nonagenarians, and age alone should not be a contraindication to SAVR in selected populations. Our sample cohort has validated the feasibility of a primary operative strategy in elderly patients with aortic stenosis and acceptable risk profiles.
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY. Electronic address: ig2006@columbia.edu.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY.
authors.forename: Halit
authors.initials: H
authors.lastname: Yerebakan
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY.
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.affiliation: Division of Cardiology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY.
authors.forename: Tamim
authors.initials: T
authors.lastname: Nazif
authors.affiliation: Division of Cardiology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY.
authors.forename: Susheel
authors.initials: S
authors.lastname: Kodali
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY; Division of Cardiology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY.
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Williams
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy; D016896:Treatment Outcome