Risk Factors and Survival after Aortic Valve Replacement in Octogenarians

Wilhelm Mistiaen, Philip Van Cauwelaert, Philip Muylaert, Floris Wuyts, Fernand Harrisson, Hilde Bortier
University of Antwerp, Belgium, Department of Cardiovascular Surgery, General Hospital Middelheim, Antwerp, Belgium
 

Background and aim of the study: The study aim was to determine if aortic valve replacement in octogenarians is still rewarding.
Methods: Between 1986 and 2000, 500 patients received a Carpentier-Edwards pericardial valve in the aortic position. Of these patients, 348 also underwent coronary artery bypass grafting (CABG). Sixty patients were aged ≥80 years. A retrospective follow up totaled 2,022 patient-years. A Cox multivariate regression analysis included 17 preoperative potential risk factors: age >80 years; gender; carcinoma; chronic obstructive pulmonary disease; renal failure; stroke; arterial hypertension; carotid artery disease; myocardial infarction; coronary artery disease; conduction defects; atrial fibrillation; medically treated endocarditis; severity of symptoms; urgent operation; left ventricular function; and need for digitalis.
Results: For hospital mortality, independent predictors were urgent surgery (Risk Ratio 10.2, 95% CI 2.5-42.0, p = 0.001); age over 80 (RR 4.5, CI 1.3-14.9; p = 0.015); need for digitalis

(RR 3.8, CI 1.3-10.6, p = 0.010); male gender (RR 3.7, CI 1.1-12.4; p = 0.035); and myocardial infarction (RR 3.1, CI 1.0-9.4, p = 0.051). For long-term mortality, independent predictors were urgent surgery (RR 4.5, CI 1.6-12.6; p = 0.004), age >80 (RR 2.5, CI 1.4-4.5, p = 0.002); myocardial infarction (RR 2.1, CI 1.3-3.4; p = 0.003); carcinoma (RR 2.0; CI 1.1-3.7; p = 0.021); and digitalis use (RR 1.8; CI 1.2-2.7; p = 0.004). Univariate analysis revealed that age >80 years (38.6% versus 77.0%), need for urgent operation (0% versus 75.1%), need for digitalis (69.4% versus 76.3%) and myocardial infarction (57.1% versus 76.4%) had a significant effect on five-year survival.
Conclusion: For hospital mortality and long-term mortality, a need for urgent surgery was the most determining factor. Age >80 years was the second most important factor, but previous myocardial infarction and need for digitalis were almost equally important. Aortic valve replacement in octogenarians is still rewarding, as five-year survival is 38.6%. Thus, surgery in these patients should not be postponed.
The Journal of Heart Valve Disease 2004;13:538-544
 
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