title: Survival and quality of life after surgical aortic valve replacement in octogenarians.
abstract: BACKGROUND
  In patients with symptomatic severe aortic stenosis, advanced age is often a reason for a transcatheter rather than surgical aortic valve replacement. In this pre-transcatheter cohort we had the unique opportunity to study outcomes after surgical aortic valve replacement for severe aortic stenosis in patients who might currently be triaged to a percutaneous approach.
  
  
  METHODS
  In a prospective single-center cohort study we compared the incidence of peri-operative complications, mortality, and health-related quality of life in octogenarians versus patients aged <80 years. The quality of life was measured using the SF-36 questionnaire and expressed as a physical and mental component score (PCS and MCS respectively); a score of 50 equals the average score in the age-matched general population. The association between age and the component scores at one-year follow-up was studied with the use of linear regression, corrected for a set of confounding variables.
  
  
  RESULTS
  We included 762 patients, of whom 21.4 % was aged >80 and 49.0 % underwent concomitant revascularization. In octogenarians, the incidence of post-operative delirium was 11.0 %, which was higher than in patients aged below 80 (6.2 %, p = 0.034); the operative mortality (1.9 % vs. 2.9 %; p = 0.59) and long-term survival were not different however (log-rank p = 0.75). In octogenarians, the quality of life was impaired 30-days after surgery (PCS 45.01, p < 0.001; MCS 48.21, p = 0.04), which improved towards or above normal values at one-year follow-up (PCS: 49.92, p = 0.67, MCS: 52.55, p < 0.001). After correction for confounding, age was not significantly associated with the one-year PCS (β 0.08 per year, p = 0.34) or MCS (β 0.08 per year, p = 0.32).
  
  
  CONCLUSIONS
  This pre-transcatheter study showed that surgical aortic valve replacement in octogenarians could be performed with very low mortality, and with a relevant and significant increase of the quality of life towards normal values. Also, age was not associated with a lower PCS or MCS one-year after surgery.
authors.affiliation: Department of Cardiology, Isala V2.2, Isala Clinics, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands. w.w.jansen.klomp@isala.nl.|Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht, 3584CG, The Netherlands. w.w.jansen.klomp@isala.nl.
authors.forename: Wouter W
authors.initials: WW
authors.lastname: Jansen Klomp
authors.affiliation: Anaesthesiology and Intensive care, Isala Clinics, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands.
authors.forename: Arno P
authors.initials: AP
authors.lastname: Nierich
authors.affiliation: Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht, 3584CG, The Netherlands.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Peelen
authors.affiliation: Cardiothoracic Surgery, Isala Clinics, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands.
authors.forename: George J
authors.initials: GJ
authors.lastname: Brandon Bravo Bruinsma
authors.affiliation: Department of Cardiology, Isala V2.2, Isala Clinics, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands.
authors.forename: Jan-Henk E
authors.initials: JE
authors.lastname: Dambrink
authors.affiliation: Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht, 3584CG, The Netherlands.
authors.forename: Karel G M
authors.initials: KGM
authors.lastname: Moons
authors.affiliation: Department of Cardiology, Isala V2.2, Isala Clinics, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands.
authors.forename: Arnoud W J
authors.initials: AWJ
authors.lastname: Van't Hof
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D003693:Delirium / Q000453:epidemiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic Valve Replacement; Aortic Valve Stenosis; Cardiac Surgery; Elderly; Octogenarian; Quality of Life