Short- and mid-term results for aortic valve replacement in octogenarians

Abstract

Population over 80 years who require surgery for degenerative aortic stenosis has largely increased in the past decades. We have compared short- and mid-term results for conventional aortic valve replacement (AVR) for calcific-degenerative aortic stenosis in older and younger than 80 years operated at our institution between April 2004 and December 2008. Predictors of mortality and major adverse cardio and cerebrovascular events (MACCEs) on the postoperative and follow-up period were determined through multivariable analysis. Four hundred and fifty-one patients were included in the study. Ninety-four (20.8%) were >or=80. Previous cardiac surgery [odds ratio (OR)=4.08, P=0.047], renal failure (OR=6.75, P<0.001), concomitant coronary artery bypass grafting (CABG) (OR=2.57, P=0.034), female sex (OR=2.49, P=0.047), and severe pulmonary hypertension (OR=3.68, P=0.024) were independent predictors of in-hospital mortality. In the follow-up, age >or=80 years [Hazard ratio (HR)=2.44, P=0.02], high blood pressure (HBP) (HR=5.2, P=0.025) and peripheral arterial disease (PAD) (HR=5.1, P<0.001) were independent predictors for late mortality. Only PAD (HR=3.55, P=0.014) and HBP (HR=8.24, P=0.04) were independent predictors for late cardiac mortality. Renal failure (OR=2.57, P=0.005), severe pulmonary hypertension (OR=3.49, P=0.005) and concomitant CABG (OR=2.49, P=0.002) were independent predictors for postoperative MACCEs. Diabetes mellitus (HR=2.03, P=0.033) and PAD (HR=2.3, P=0.041) were independent predictors for MACCEs in the follow-up. According to these data, we can conclude that conventional open AVR for degenerative aortic stenosis grants good early- and mid-term outcomes in octogenarians in our experience.

Prognostic Implications of Pulmonary Hypertension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

“…[3][4][5][6][7][8] The present study shows that PH was also a predictive factor of 1-year mortality after TAVI; on multivariate analysis, mild-to-moderate and especially severe PH emerged as an independent factor of mortality (HR, 1.22; 95% CI, 0.96-1.54 and HR, 1.33; 95% CI, 1.01-1.75, respectively). Tamburino et al 11 likewise reported that severe PH correlated with overall mortality (HR, 3.21), but they did not study the role of mild-to-moderate PH.…”

“…[3][4][5] In patients undergoing surgical aortic valve replacement (AVR), PH has been found to be an independent predictor of major adverse cardiovascular events, significantly increasing mortality. [3][4][5][6][7][8] Although AVR in the presence of PH is associated with higher complications rates, potential benefits outweigh the risks of surgery. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to AVR in high-risk patients with contraindications for surgery.…”

Long-Term Quality of Life after Cardiac and Thoracic Aortic Surgery for Very Elderly Patients 85 Years or Older

“…9,10) According to various reports, in-hospital mortality after AVR for aortic stenosis ranges from 3.2% to 9% for patients 80 years or older and from 2.9% to 7.4% for younger patients or patients of all ages; therefore, the difference between these rates is minimal. [11][12][13][14] Even in patients undergoing AVR combined with CABG, shortterm and long-term outcomes do not vary greatly 13) ; moreover, there was no difference in mortality, incidence of acute cerebrovascular events and postoperative myocardial infarction, postoperative dialysis rate, frequency of pacemaker placement, and incidence of major cardiovascular events including mediastinitis. An age of 80 years or older is a predictive factor for late death, but it is not considered to be a predictive factor for heartrelated death or major cardiovascular events.…”

“…11) The 5-year survival rate for patients 80 years or older undergoing AVR alone ranges from 56% to 90%. [11][12][13] According to the cohort life table issued in 2013 by the Center for Cancer Control and Information Services at the Japan National Cancer Center, the Japanese general population data from the year 2000 show 5-year survival rates of 67% for men aged 80 years and 81% for women aged 80 years. Although these rates cannot be strictly compared due to differences between Japanese and overseas data, the postoperative survival rates do not appear to be inferior to the rates shown in the life table.…”

“…Sporadic reports have also described older age among cardiovascular surgery patients. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] For elderly patients, the indications for surgery should be considered while accounting for various risks, which differ from those for younger patients. Cardiovascular surgery for elderly patients aged ≥85 years is associated with very high risk, and we have to carefully consider surgical treatment for these patients.…”