title: Perioperative predictors of midterm survival after aortic valve replacement.
abstract: BACKGROUND
  Elderly patients with aortic stenosis are under-referred for aortic valve replacement surgery. This study investigated the perioperative factors associated with midterm outcomes in a consecutive series of patients undergoing aortic valve replacement with or without coronary artery bypass graft surgery.
  
  
  METHODS
  From 2006 to 2010, 509 patients having aortic valve replacement or aortic valve replacement with coronary artery bypass were grouped according to age (<80 years and ≥80 years) and procedure (aortic valve replacement ± coronary artery bypass). Patient survival was followed up for 5 years (mean 2.6 years). Midterm survival was evaluated using Kaplan-Meier and Cox proportional hazards regression model statistics.
  
  
  CONCLUSIONS
  5-year survival among octogenarians was 59.2% with an observed 30-day mortality of 1% for aortic valve replacement and 3% for aortic valve replacement with coronary artery bypass. Kaplan-Meier survival analysis showed that age ≥80 years, New York Heart Association functional class III/IV, and left ventricular ejection fraction <35% were significantly associated with increased midterm mortality. Cox regression modeling demonstrated that age ≥80 years was the only significant independent factor associated with midterm mortality; older patients had a 3-fold increase in mortality (adjusted hazard ratio = 3.231, 95% confidence interval: 1.764-5.920, p < 0.0001). While hospital and 30-day mortality were not statistically different between age groups, age ≥80 years was the most powerful predictor of midterm death. These results support early aortic valve replacement with or without coronary artery bypass in aortic stenosis management.
authors.affiliation: The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA University of Pennsylvania School of Medicine, Glenolden, PA, USA jbg2136@columbia.edu.
authors.forename: Juan B
authors.initials: JB
authors.lastname: Grau
authors.affiliation: The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA.
authors.forename: Andrew Wc
authors.initials: AW
authors.lastname: Mak
authors.affiliation: The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA University of Pennsylvania School of Medicine, Glenolden, PA, USA.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ferrari
authors.affiliation: The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Johnson
authors.affiliation: The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.affiliation: The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Sperling
authors.affiliation: The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Brizzio
authors.affiliation: The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Zapolanski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / 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; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: 80 and over; Aged; Aortic valve stenosis; Coronary artery bypass; Heart failure; Heart valve prosthesis implantation; Survival analysis