Aortic valve replacement in over 70- and over 80-year olds: 5-year cohort study. (June 2014)

• Record Type: Journal Article
• Authors: Wang, Tom Kai Ming; Sathananthan, Janarthanan; Chieng, Nicholas; Gamble, Greg D; Haydock, David A; Ruygrok, Peter N
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 22:Number 5(2014)
• Page Start: 526
• Page End: 533
• Publication Date: 2014-06
• Subjects: aged -- 80 and over -- aortic valve -- aortic valve stenosis -- heart valve prosthesis implantation -- postoperative complications; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492313497950
• Languages: English
• ISSNs: 0218-4923

Abstract

Background: Demand for aortic valve intervention remains high, and together with the recent introduction of transcatheter aortic valve implantation, this motivates a review of surgical aortic valve replacement in elderly recipients. Methods: Consecutive patients over 70 years of age having isolated aortic valve replacement during 2007–11 were retrospectively identified and divided into 70–79 and ≥ 80 years age groups for analyses. Results: 62 octogenarians and 121 septuagenarians were eligible. Among octogenarians, a lower proportion were in Canadian Cardiovascular Society angina class 3–4 (3.2% vs. 14.0%, p = 0.022) and fewer had diabetes (11.3% vs. 24.8%, p = 0.034), but a higher proportion had infective endocarditis (6.5% vs. 0%, p = 0.012), and EuroSCORE II was higher (4.9% vs. 3.7%, p < 0.001). Despite this, operative mortality was lower in octogenarians (0% vs. 7.4%, p = 0.029), although hospital stay (11.7 vs. 8.9 days, p = 0.026) was longer. One-, 3-, and 5-year survival rates were 95.2%, 90.1%, and 75.3% for octogenarians and 89.2%, 81.7%, and 70.2% for septuagenarians ( p = 0.398). Canadian Cardiovascular Society angina class 3–4 and the presence of other valvular stenosis or regurgitation were independent predictors of mortality. Conclusion: Octogenarians had lower operative mortality despite a higher predicted risk preoperatively. Other factors beyond age and EuroSCORE, such as frailty, may be important in deciding whether elderly patients should undergo aortic valve replacement.