Evaluation of Operative Risk in Elderly Patients Undergoing Aortic Valve Replacement: The Predictive Value of Operative Risk Scores

Abstract

Objectives: An increasing number of elderly patients develop aortic valve disease requiring surgery. Operative risk scores are currently used to identify patients at high operative risk who may benefit from interventional treatment options. The aim of this study was to analyze the predictive value of these risk scores in geriatric patients undergoing aortic valve replacement. Methods: We reviewed data of 1,245 elderly patients who underwent aortic valve replacement with or without additional bypass surgery from 2000–2007. Patient data were derived from a prospective registry at the Department of Cardiac Surgery at Albertinen-Hospital in Hamburg, Germany. Results: Hospital mortality was 2.56% in isolated valve replacement and 3.38% in patients who had additional bypass surgery (p = ns). Age >80 years (OR 1.7; 95% CI: 1.3–3.3) and renal failure (OR 1.6; 95% CI: 1.1–2.5) were significantly associated with in-hospital death. All scores overestimated operative mortality. The median logistic EuroSCORE was 11.56% (interquartile range: 7.01–18.96), median STS score 13.9% (10.3–16.2); and median Ambler score 7.2% (4.1–9.3). There was a significant correlation of the STS score with operative mortality (Spearman’s rank coefficient: 0.68), but not with EuroSCORE (Spearman’s rank coefficient: 0.11) or Ambler score (Spearman’s rank coefficient: –0.17). Conclusion: Current risk scores overestimate operative risk in geriatric patients undergoing aortic valve replacement substantially. Of the risk scores evaluated, only STS score correlated significantly with operative mortality. Operative risk scores aimed specifically at geriatric patients may be necessary to accurately identify patients at high operative risk who benefit from non-surgical treatment options.

Early and Late Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation: Comparison of the Novel EuroScore II with Established Risk Scores

“…Predicted mortality varies considerably depending on the risk score utilized as different variables with diverse weighting are incorporated. All scores were derived from cardiac databases of patients undergoing cardiac surgery, mainly coronary artery bypass grafting, and both age and risk profiles of patients undergoing cardiovascular procedures have changed considerably since the logistic EuroScore and the STS-PROM score were established [34]. With regard to TAVI, patients evaluated for transcatheter procedures are somewhat different to those scheduled for heart surgery.…”

Off-pump coronary artery bypass grafting in combination with transaortic transcatheter aortic valve implantation: A possible approach for patients with associated diseases

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Although there are no definite criteria for transcatheter aortic valve implantation (TAVI), this procedure is now extensively used in patients considered to be too high at risk for standard surgical aortic valve replacement (AVR) using cardiopulmonary bypass (CPB) [1]. Therefore, in tertiary referral centers, patients eligible for a TAVI procedure often show severe coronary artery disease requiring revascularization that can be performed by percutaneous coronary intervention, if feasible, or by coronary artery bypass grafting (CABG), as recommended by current guidelines [2].

Moreover, it is reasonable that high-risk patients not eligible for conventional AVR should be considered at even higher risk for a combined procedure as CABG plus AVR using CPB.

We report the first case of a patient with coronary artery disease and severe aortic stenosis undergoing AVR associated with CABG without using CPB.

In June 2011, an 88-year-old female patient requiring AVR for severe symptomatic calcified aortic stenosis (NYHA class III and AVA 0.56 cm 2 /m 2 ) was referred to our institution.

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Sutureless valve implantation in a patient with bicuspid aortic valve

“…Surgical candidates often show multiple comorbid conditions, and new implantation techniques have been developed to minimize the surgical risk [1].…”

“…In addition, these patients frequently have multiple comobidities that impose an increased risk of complications both during and after surgery [1]. Recent data from a multicenter registry have demonstrated a high success rate of transcatheter aortic valve implantation with moderate in-hospital complications [5].…”