Original articleAdult cardiacAortic Valve Replacement in Octogenarians: Utility of Risk Stratification With EuroSCORE
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)
- et al.
Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in northern New England
Ann Thorac Surg
(2004) - et al.
Aortic valve replacement in octogenarians with severe aortic stenosisExperience in a series of consecutive patients at a single center
Rev Esp Cardiol
(2007) - et al.
Reliability of risk algorithms in predicting early and late operative outcomes in high risk patients undergoing aortic valve replacement
J Thorac Cardiovasc Surg
(2008) - et al.
Clinical factors associated with calcific aortic valve diseaseCardiovascular Health Study
J Am Coll Cardiol
(1997) - et al.
Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample
J Am Coll Cardiol
(1993) - et al.
Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis
Ann Thorac Surg
(2006) - et al.
Stentless versus conventional xenograft aortic valve replacement: midterm results of a prospectively randomized trial
Ann Thorac Surg
(2007) - et al.
Cost-effectiveness of aortic valve replacement in the elderly: an introductory study
J Thorac Cardiovasc Surg
(2007) - et al.
The Toronto risk score for adverse events following cardiac surgery
Can J Cardiol
(2006) - et al.
Outcome after aortic valve replacement in octogenarians
Ann Thorac Surg
(2004)
Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy
Ann Thorac Surg
Current determinants of operative mortality in 1400 patients requiring aortic valve replacement
Ann Thorac Surg
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
Germany 2004Statistical year book for the Federal Republic of Germany 2005
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
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