title: Predictive factors of long-term survival in the octogenarian undergoing surgical aortic valve replacement: 12-year single-centre follow-up.
abstract: The improvement of life expectancy created more surgical candidates with severe symptomatic aortic stenosis and age >80. Therefore, the main objective of this observational, retrospective single-centre study is to compare the long-term survival of octogenarians that have undergone surgical aortic valve replacement (AVR) to the survival of the general population of the same age and to establish whether any perioperative characteristics can anticipate a poor long-term result, limiting the prognostic advantage of the procedure at this age. From 2000 to 2014, 264 octogenarians underwent AVR at our institution. Perioperative data were retrieved from our institutional database and patients were followed up by telephonic interviews. The follow-up ranged between 2 months and 14.9 years (mean 4.1 ± 3.1 years) and the completeness was 99.2 %. Logistic multivariate analysis and Cox regression were respectively applied to identify the risk factors of in-hospital mortality and follow-up survival. Our patient population ages ranged between 80 and 88 years. Isolated AVR (I-AVR) was performed in 136 patients (51.5 %) whereas combined AVR (C-AVR) in 128 patients (48.5 %). Elective procedures were 93.1 %. Logistic EuroSCORE was 15.4 ± 10.6. In-hospital mortality was 4.5 %. Predictive factors of in-hospital mortality were the non-elective priority of the procedure (OR 5.7, CI 1.28-25.7, p = 0.02), cardiopulmonary bypass time (OR 1.02, CI 1.01-1.03, p = 0.004) and age (OR 1.36, CI 1.01-1.84, p = 0.04). Follow-up survival at 1, 4, 8 and 12 years was 93.4 % ± 1.6 %, 72.1 % ± 3.3 %, 39.1 % ± 4.8 % and 20.1 % ± 5.7 %, respectively. The long-term survival of these patients was not statistically different from the survival of an age/gender-matched general population living in the same geographic region (p = 0.52). Predictive factors of poor long-term survival were diabetes mellitus (HR 1.55, CI 1.01-2.46, p = 0.05), preoperative creatinine >200 μmol/L (HR 2.07, CI 1.21-3.53, p = 0.007) and preoperative atrial fibrillation (HR 1.79, CI 1.14-2.80, p = 0.01). In our experience, AVR can be safely performed in octogenarians. After a successful operation, the survival of these patients returns similar to the general population. Nevertheless, the preoperative presence of major comorbidities such as diabetes mellitus, renal dysfunction and atrial fibrillation significantly impact on long-term results.
authors: Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy. giangi.cappabianca@gmail.com.
authors: Giangiuseppe
authors: G
authors: Cappabianca
authors: Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
authors: Sandro
authors: S
authors: Ferrarese
authors: Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
authors: Andrea
authors: A
authors: Musazzi
authors: Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
authors: Francesco
authors: F
authors: Terrieri
authors: Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
authors: Claudio
authors: C
authors: Corazzari
authors: Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
authors: Matteo
authors: M
authors: Matteucci
authors: Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
authors: Cesare
authors: C
authors: Beghi
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015897:Comorbidity; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic valve replacement; Long-term follow-up; Octogenarian