Original article
Adult cardiac
Aortic Valve Replacement in Octogenarians: Utility of Risk Stratification With EuroSCORE

https://doi.org/10.1016/j.athoracsur.2009.01.057Get rights and content

Background

With the advent of percutaneous valve implantation, an increasing amount of interest is being expressed in outcomes of conventional aortic valve replacement (AVR) in elderly patients. We evaluated characteristics and outcomes of elderly patients undergoing isolated AVR with a particular focus on the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification.

Methods

All patients aged 80 years or older (n = 282) undergoing isolated AVR between November 1995 and June 2006 at our institution were reviewed according to logistic EuroSCORE (ESlog) risk stratification. Surgical risk was defined as low risk (ESlog ≤ 10% [n = 107]), moderate risk (10% < ESlog < 20% [n = 103]), and high risk (ESlog ≥ 20% [n = 72]). Patient age was 82 ± 2 years (low risk), 82.7 ± 2.7 years (moderate risk), and 83.6 ± 3.1 years (high risk), respectively (p < 0.05). Mean ESlog predicted risk of mortality was 7.3% ± 1.4% (low risk), 13.7% ± 2.5% (moderate risk), and 33.0% ± 11.5% (high risk; p < 0.05). Follow-up was 99.7% complete.

Results

In-hospital mortality was 7.5% (low risk), 12.6% (moderate risk), and 12.5% (high risk; p = 0.4). One-year survival was 90%, 78%, and 69% (p = 0.002); 5-year survival was 70%, 53%, and 38% (p = 0.05); and 8-year survival was 38%, 33%, and 21% (p = 0.017), for low-, moderate-, and high-risk patients, respectively. Independent predictors for in-hospital mortality were pulmonary hypertension and urgent indication for surgery. Cox regression predictors of medium-term survival were congestive heart failure, urgent timing, previous stroke or transient ischemic attack, and EuroSCORE stratum.

Conclusions

Aortic valve replacement can be performed in the elderly population with acceptable outcomes. EuroSCORE risk stratification is imprecise for prediction of perioperative mortality among octogenarian AVR patients, but may be useful for predicting mortality during medium-term follow-up.

Section snippets

Material and Methods

All patients 80 years of age or older undergoing isolated AVR at our institution between November 1996 and June 2006 (n = 282) were included in this study. Patient details were evaluated retrospectively through our hospital database, which was designed with prospective data entry. Follow-up evaluations were performed annually by contact with the patient or patient's family, as well as with the patient's family physician or cardiologist. Ethics approval was obtained from the local Ethics Review

Results

The mean patient age was 82.7 ± 2.7 years (range, 80 to 93). Approximately two thirds of the patients (67.4%) were female. Indication for AVR was aortic valve stenosis (n = 164; 58.2%), combined lesion with predominant stenosis (n = 110; 39.0%), and aortic valve incompetence (n = 8; 2.8%). The clinical profile of the patients is depicted in Table 1. The mean ESlog predicted risk of mortality for all patients was 16.2% ± 11.9%. Patients were separated into three groups according to ESlog scores:

Comment

An increasing life expectancy in industrialized countries has led to a steady increase in the number of octogenarians undergoing cardiac surgery. More than 25% of octogenarians are functionally limited by cardiovascular disease [10]. Furthermore, aortic valve disease is the most commonly acquired heart valve lesion in this age group, being present in approximately 4% of octogenarians [4, 11, 12,]. Despite the frequency of this disease process, aortic stenosis is probably undertreated in elderly

References (31)

  • M. Kirsch et al.

    Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy

    Ann Thorac Surg

    (1998)
  • I. Florath et al.

    Current determinants of operative mortality in 1400 patients requiring aortic valve replacement

    Ann Thorac Surg

    (2003)
  • E. Grube et al.

    Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome

    J Am Coll Cardiol

    (2007)
  • Germany 2004Statistical year book for the Federal Republic of Germany 2005

    (2005)
  • R.O. Bonow et al.

    ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease), developed in collaboration with the Society of Cardiovascular Anesthesiologists, endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons

    Circulation

    (2006)
  • Cited by (188)

    • Cardiovascular Risk Assessment in Cardiac Surgery

      2021, Perioperative Medicine: Managing for Outcome, Second Edition
    • Mini-Sternotomy Versus Conventional Sternotomy for Aortic Valve Replacement

      2019, Journal of the American College of Cardiology
    • TAC for TAVR: What Is the Score?

      2019, JACC: Cardiovascular Imaging
    View all citing articles on Scopus
    View full text