Aortic Root Replacement in Octogenarians Offers Acceptable Perioperative and Late Outcomes.
BACKGROUND
As the proportion of the population more than 80 years of age increases, cardiac surgeons will increasingly be consulted to operate on this high-risk patient group. The aim of this study is to evaluate the perioperative and late outcomes of octogenarians undergoing aortic root replacement in comparison with younger patients.


METHODS
All patients undergoing aortic root replacement at our institution between 2005 and 2012 (n = 592) were retrospectively reviewed. Patients were stratified according to their age at surgery: patients less than 80 years old (group LT80, n = 558) and octogenarians (group OG, n = 34). Primary outcomes of interest were inhospital mortality and perioperative complication rate.


RESULTS
Patients in the OG group had significantly higher rates of preoperative stroke history, atrial fibrillation, and coronary artery disease. Indication for surgery was type A aortic dissection in 62 (10.5%), thoracic aortic aneurysm in 514 (86.8%), and endocarditis in 11 (1.9%), with no intergroup differences. Inhospital mortality was not significantly different between groups (5.9% OG versus 2.3% LT80, p = 0.21), and postoperative atrial fibrillation was more common in OG (60.6% OG versus 38.5% LT80, p = 0.01). Type A dissection, diabetes mellitus, and prior cardiac surgery were independent predictors of inhospital mortality or postoperative stroke.


CONCLUSIONS
Octogenarians can safely undergo aortic root replacement with moderately worse but acceptable perioperative mortality and late survival. Further studies are necessary to determine which subset of octogenarians are at the highest operative risk and may benefit from a conservative approach.
Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
Robert A
RA
Sorabella
Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
Yeu Sanz
YS
Wu
Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
Amanda
A
Bader
Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
Min Jeong
MJ
Kim
Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
Craig R
CR
Smith
Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
Hiroo
H
Takayama
Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
Michael A
MA
Borger
Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: ig2006@cumc.columbia.edu.
Isaac
I
George
D000367:Age Factors; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D059035:Perioperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology