title: Aortic valve replacement for severe aortic stenosis in octogenarians: patient outcomes and comparison of operative risk scores.
abstract: OBJECTIVE
  Isolated aortic valve replacement (AVR) in octogenarians is associated with increased operative risk, due to higher prevalence of associated risk factors and other comorbidities, making outcome prediction essential. We sought to analyze operative mortality and morbidity and to compare the predictive accuracy of the logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) I, EuroSCORE II and Society of Thoracic Surgeons (STS) score in this population.
  
  
  METHODS
  We retrospectively enrolled 106 consecutive octogenarians with symptomatic severe aortic stenosis undergoing isolated AVR in a large-volume single center between January 2003 and December 2010 and calculated surgical risk scores.
  
  
  RESULTS
  Mean logistic EuroSCORE I, EuroSCORE II and STS score were 14.6±11, 4.4±3.1 and 4.0±2.4%, respectively. Mean operative mortality was 5.7% (six patients). Two (1.9%) patients suffered an ischemic stroke, three (2.8%) required temporary hemodialysis and five (4.7%) had a permanent pacemaker implanted. Five (4.7%) required rethoracotomy. No myocardial infarction or sternal wound infection was observed. Calibration-in-the-large showed overestimation of operative mortality with logistic EuroSCORE I (p=0.036), whereas EuroSCORE II (p=1.0) and STS (p=1.0) showed good calibration. C-statistic values were 0.877 (95% CI 0.800-0.933) for logistic EuroSCORE I, 0.792 (95% CI 0.702-0.864) for EuroSCORE II and 0.702 (95% CI 0.605-0.787) for STS, without statistically significant differences.
  
  
  CONCLUSIONS
  These results suggest that AVR can be performed safely in selected octogenarians. EuroSCORE II and STS demonstrated superior calibration and should be the preferred tools for risk assessment, at least for this population.
authors.affiliation: Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiology, Carnaxide, Portugal. Electronic address: atralhao@gmail.com.
authors.forename: António
authors.initials: A
authors.lastname: Tralhão
authors.affiliation: Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiology, Carnaxide, Portugal.
authors.forename: Rui Campante
authors.initials: RC
authors.lastname: Teles
authors.affiliation: Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiology, Carnaxide, Portugal.
authors.forename: Manuel Sousa
authors.initials: MS
authors.lastname: Almeida
authors.affiliation: Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiology, Carnaxide, Portugal.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Madeira
authors.affiliation: Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiology, Carnaxide, Portugal.
authors.forename: Miguel Borges
authors.initials: MB
authors.lastname: Santos
authors.affiliation: Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiology, Carnaxide, Portugal.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Andrade
authors.affiliation: Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiology, Carnaxide, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
authors.affiliation: Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiothoracic Surgery, Carnaxide, Portugal.
authors.forename: José Pedro
authors.initials: JP
authors.lastname: Neves
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Aortic stenosis; Aortic valve surgery; Avaliação do risco; Cirurgia valvular aórtica; Estenose aórtica; EuroSCORE; Octogenarians; Octogenários; Risk assessment; STS score