title: Early and late outcomes of AVR with aortic annular enlargement in octogenarian.
abstract: OBJECTIVE
  There is no clear consensus on the procedures for octogenarians with a small aortic annulus who require aortic valve replacement (AVR). We evaluated surgical results in octogenarians who underwent AVR with aortic annular enlargement, Nicks procedure, for aortic stenosis with a small aortic annulus.
  
  
  METHODS
  Between January 2001 and March 2014, 131 octogenarian patients were treated at our institution. Nineteen patients received AVR with aortic annular enlargement (AAE group), and the others received standard AVR without annular enlargement (sAVR group). We compared early and late outcomes between the two groups.
  
  
  RESULTS
  There were no significant differences in early complications between the groups. The rates for use of a mechanical valve (32 vs 22 %, p = 0.590), in-hospital mortality (5.3 vs 5.4 %, p = 1.000), and severe patient-prosthesis mismatch (PPM) (0 vs 6.3 %, p = 0.593) were also similar between the AAE and sAVR group. In the AAE group, there was no cardiac-related death, bleeding event, thromboembolism, or stroke during the follow-up period (mean 37.6 months). The rates of freedom from cardiac events at 8 years were 94 % in the AAE group and 57 % in the sAVR group (p = 0.292). The overall survival rates at 8 years were 77 % in the AAE group and 77 % in sAVR group (p = 0.462). There were no significant differences in these rates between the groups.
  
  
  CONCLUSIONS
  AVR with aortic annular enlargement in octogenarians with small aortic annulus was safe and led to good operative and long-term outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Tachikawa Medical Center, 3-2-11 Kanda-cho, Nagaoka, Niigata, 940-0052, Japan, yamanashimedical@yahoo.co.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Shinpei
authors.initials: S
authors.lastname: Yoshii
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome