title: Expectation and quality of life after aortic valve replacement over 85 years of age match those of the contemporary general population.
abstract: BACKGROUND
  In the transcatheter aortic valve implantation (TAVI) years, very elderly patients with aortic stenosis (AS) are referred to surgery with reluctance despite excellent hospital outcomes. A poorly assessed outcome of discharged survivors might further overlook the actual efficacy of the surgical strategy in this cohort. We thus evaluated life-expectancy and functional results in discharged survivors over 85 years operated on for AS.
  
  
  METHODS
  Between January 2001 and December 2013, 57 consecutive patients aged ≥85 years underwent aortic valve replacement (AVR) with or without concomitant procedures at our institution. Late survival rate (SR), New York Heart Associaion (NYHA) functional class and quality of life (RAND SF-36) were assessed. SR and quality of life (QoL) were than compared to the contemporary general population matched for age and gender, as calculated by the Italian National Institute of Statistics.
  
  
  RESULTS
  Overall in-hospital mortality was 8.8% (5 pts). In patients without concomitant coronary artery bypass grafting (CABG), in-hospital mortality was 2.9%. Survival at 5 and 9 years was 57.7 ± 8.4% and 17.9 ± 11.4%, respectively. No predictors of late mortality including concomitant CABG were identified at Cox analysis. The mean NYHA class for long-term survivors improved from 3.1 to 1.6 (p&lt;0.001). Survivors reported better QoL-scores compared to the age- and gender-matched contemporary general population in 4 RAND SF-36 domains. Life-expectancy resulted comparable to that predicted for the age and gender-matched general population.
  
  
  CONCLUSIONS
  Isolated AVR in patients aged ≥85 years can be performed with acceptable risk. Survivors improve in NYHA class and, when compared to age- and gender-matched individuals, show a similar life expectancy and a no lower QoL.
authors.affiliation: Division of Cardiac Surgery, IRCCS San Martino - IST University Hospital, University of Genoa, Genoa - Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Salsano
authors.affiliation: Division of Cardiac Surgery, IRCCS San Martino - IST University Hospital, University of Genoa, Genoa - Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Regesta
authors.affiliation: Division of Cardiac Surgery, IRCCS San Martino - IST University Hospital, University of Genoa, Genoa - Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Viganò
authors.affiliation: Division of Cardiac Surgery, IRCCS San Martino - IST University Hospital, University of Genoa, Genoa - Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Rapetto
authors.affiliation: Division of Cardiac Surgery, IRCCS San Martino - IST University Hospital, University of Genoa, Genoa - Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Boeddu
authors.affiliation: Division of Cardiac Surgery, IRCCS San Martino - IST University Hospital, University of Genoa, Genoa - Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Sportelli
authors.affiliation: Division of Cardiac Surgery, IRCCS San Martino - IST University Hospital, University of Genoa, Genoa - Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pansini
authors.affiliation: Department of Epidemiology and Social Psychiatry, IRCCS - Mario Negri Institute of Pharmacological Research, Milan - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Risso
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Division of Cardiac Surgery, IRCCS San Martino - IST University Hospital, University of Genoa, Genoa - Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Passerone
authors.affiliation: Division of Cardiac Surgery, IRCCS San Martino - IST University Hospital, University of Genoa, Genoa - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008017:Life Expectancy; D008297:Male; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome