title: Aortic valve replacement in over 70- and over 80-year olds: 5-year cohort study.
abstract: BACKGROUND
  Demand for aortic valve intervention remains high, and together with the recent introduction of transcatheter aortic valve implantation, this motivates a review of surgical aortic valve replacement in elderly recipients.
  
  
  METHODS
  Consecutive patients over 70 years of age having isolated aortic valve replacement during 2007-11 were retrospectively identified and divided into 70-79 and ≥ 80 years age groups for analyses.
  
  
  RESULTS
  62 octogenarians and 121 septuagenarians were eligible. Among octogenarians, a lower proportion were in Canadian Cardiovascular Society angina class 3-4 (3.2% vs. 14.0%, p = 0.022) and fewer had diabetes (11.3% vs. 24.8%, p = 0.034), but a higher proportion had infective endocarditis (6.5% vs. 0%, p = 0.012), and EuroSCORE II was higher (4.9% vs. 3.7%, p < 0.001). Despite this, operative mortality was lower in octogenarians (0% vs. 7.4%, p = 0.029), although hospital stay (11.7 vs. 8.9 days, p = 0.026) was longer. One-, 3-, and 5-year survival rates were 95.2%, 90.1%, and 75.3% for octogenarians and 89.2%, 81.7%, and 70.2% for septuagenarians (p = 0.398). Canadian Cardiovascular Society angina class 3-4 and the presence of other valvular stenosis or regurgitation were independent predictors of mortality.
  
  
  CONCLUSIONS
  Octogenarians had lower operative mortality despite a higher predicted risk preoperatively. Other factors beyond age and EuroSCORE, such as frailty, may be important in deciding whether elderly patients should undergo aortic valve replacement.
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand TWang@adhb.govt.nz.
authors.forename: Tom Kai Ming
authors.initials: TK
authors.lastname: Wang
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Janarthanan
authors.initials: J
authors.lastname: Sathananthan
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Chieng
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Greg D
authors.initials: GD
authors.lastname: Gamble
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: David A
authors.initials: DA
authors.lastname: Haydock
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Ruygrok
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D015897:Comorbidity; D006349:Heart Valve Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: 80 and over; aged; aortic valve; aortic valve stenosis; heart valve prosthesis implantation; postoperative complications