Contemporary outcomes of conventional aortic valve replacement in 638 octogenarians: insights from an Italian Regional Cardiac Surgery Registry (RERIC)

• Published in: European journal of cardio-thoracic surgery 2012-06, Vol.41 (6), p.1247-1253
• Main Authors: Di Eusanio, Marco, Fortuna, Daniela, Cristell, Donald, Pugliese, Peppino, Nicolini, Francesco, Pacini, Davide, Gabbieri, Davide, Lamarra, Mauro
• Format: Article
• Language: English
• Subjects: Age Factors; Aged, 80 and over; Aortic Valve - surgery; Biological and medical sciences; Cardiology. Vascular system; Female; Follow-Up Studies; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Italy - epidemiology; Kaplan-Meier Estimate; Male; Medical sciences; Pneumology; Registries; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezr204

OBJECTIVES Few data exist on contemporary outcomes after conventional aortic valve replacement (AVR) in the elderly. Accordingly, we evaluated contemporary outcomes and identified predictors of reduced survival in a large series of octogenarians undergoing AVR. METHODS The Regione Emilia Romagna Cardiac Surgery registry (RERIC) database (n =26938) was queried for clinical features, hospital and mid-term outcomes of octogenarians undergoing AVR between 2003 and 2009. Predictors of hospital and mid-term mortality were identified. RESULTS The study population consisted of 638 patients. NYHA class III-IV, congestive heart failure, cerebrovascular disease, extra-cardiac arteriopathy, mostly exacerbated patients' clinical profile. Mean log-EuroSCORE was 13.0%. Overall hospital mortality and stroke rates were 4.5% and 1.3%, respectively. Other post-operative complications included renal failure (4.9%), intubation time >48 h (3.4%), complete atrio-ventricular block (4.4%). NYHA III-IV (OR=2.7; CI 95%:1.2-6.7) and CCS III-IV (OR=3.1; CI 95%:1.1-9.4) emerged as independent predictors of hospital mortality on multivariate analysis. At 6 years, octogenarians' survival rate was similar to the expected survival of the age- and sex-matched regional population. CCS III-IV (HR=2.1; CI 95%:1.2-4), preoperative creatinine > 2.1 (HR=2.8; CI 95%:1.4-5.9), extra-cardiac arteriopathy (HR=1.5; CI 95%:1.1-2.1) and peripheral neurological dysfunction (HR=3.8; CI 95%:1.4-10.4) emerged as independent risk factors for decreased 6 years' survival. CONCLUSIONS This study, showing that contemporary outcomes after AVR are excellent, may help to improve treatment decision-making in elderly patients with aortic valve disease.