Aortic valve replacement in octogenarians: identification of high-risk patients
Objective: This study identifies high-risk octogenarians for surgical aortic valve replacement (AVR) because with the current advances in transcatheter valve therapy, a definition of patient selection criteria is essential. Methods: Between 1996 and 2006, 493 consecutive octogenarians with symptomat...
| Main Authors: | , , , , |
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| Format: | Journal Article |
| Published: |
2010
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| Online Access: | http://hdl.handle.net/20.500.11937/13177 |
| _version_ | 1848748277938257920 |
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| author | Florath, Ines Albert, A. Boening, A. Ennker, I. Ennker, J. |
| author_facet | Florath, Ines Albert, A. Boening, A. Ennker, I. Ennker, J. |
| author_sort | Florath, Ines |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Objective: This study identifies high-risk octogenarians for surgical aortic valve replacement (AVR) because with the current advances in transcatheter valve therapy, a definition of patient selection criteria is essential. Methods: Between 1996 and 2006, 493 consecutive octogenarians with symptomatic aortic stenosis underwent AVR with and without (51%) concomitant coronary artery bypass grafting (CABG). To identify high-risk patient groups, risk factors of 6-month mortality were determined using multivariable logistic regression. Results: The 30-day mortality rate was 8.4% and it increased up to 15.2% until 6 months after AVR. Independent risk factors of 6-month mortality were patients older than 84 years (odds ratio (OR): 2.2 (1.29-3.61)), left ventricular ejection fraction <60% (OR: 2.5 (1.35-4.61)), body mass index (BMI) <24 (OR: 2.0 (1.22-3.36)), creatinine (OR: 1.6 (1.04-2.53)) and blood glucose (OR: 1.01 (1.001-1.009)). High-risk groups were patients older than 84 years with an ejection fraction <60% (6-month mortality 28%) and patients younger than 84 years with an ejection fraction <60% and a BMI <24 (6-month mortality 23.2%). These high-risk groups comprised 37% of the patient population. After isolated AVR, the 30-day mortality and survival at 1 and 5 years was 11.6%, 69% and 35% in this high-risk group, respectively. In octogenarians with an STS score >10 and an EuroScore >20, the 30-day mortality and survival at 1 year was 10.5% and 80%, 11.6% and 77%, respectively. Conclusions: In most octogenarians, AVR is a safe and beneficial procedure. In high-risk octogenarians, identified by STS score >10, EuroScore >20 and by simple three risk factors (age >84 years, ejection fraction <60% and BMI <24), the mortality after surgical AVR was no different from the currently reported outcome after transcatheter AVI. © 2009 European Association for Cardio-Thoracic Surgery. |
| first_indexed | 2025-11-14T07:02:30Z |
| format | Journal Article |
| id | curtin-20.500.11937-13177 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T07:02:30Z |
| publishDate | 2010 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-131772017-09-13T14:56:51Z Aortic valve replacement in octogenarians: identification of high-risk patients Florath, Ines Albert, A. Boening, A. Ennker, I. Ennker, J. Objective: This study identifies high-risk octogenarians for surgical aortic valve replacement (AVR) because with the current advances in transcatheter valve therapy, a definition of patient selection criteria is essential. Methods: Between 1996 and 2006, 493 consecutive octogenarians with symptomatic aortic stenosis underwent AVR with and without (51%) concomitant coronary artery bypass grafting (CABG). To identify high-risk patient groups, risk factors of 6-month mortality were determined using multivariable logistic regression. Results: The 30-day mortality rate was 8.4% and it increased up to 15.2% until 6 months after AVR. Independent risk factors of 6-month mortality were patients older than 84 years (odds ratio (OR): 2.2 (1.29-3.61)), left ventricular ejection fraction <60% (OR: 2.5 (1.35-4.61)), body mass index (BMI) <24 (OR: 2.0 (1.22-3.36)), creatinine (OR: 1.6 (1.04-2.53)) and blood glucose (OR: 1.01 (1.001-1.009)). High-risk groups were patients older than 84 years with an ejection fraction <60% (6-month mortality 28%) and patients younger than 84 years with an ejection fraction <60% and a BMI <24 (6-month mortality 23.2%). These high-risk groups comprised 37% of the patient population. After isolated AVR, the 30-day mortality and survival at 1 and 5 years was 11.6%, 69% and 35% in this high-risk group, respectively. In octogenarians with an STS score >10 and an EuroScore >20, the 30-day mortality and survival at 1 year was 10.5% and 80%, 11.6% and 77%, respectively. Conclusions: In most octogenarians, AVR is a safe and beneficial procedure. In high-risk octogenarians, identified by STS score >10, EuroScore >20 and by simple three risk factors (age >84 years, ejection fraction <60% and BMI <24), the mortality after surgical AVR was no different from the currently reported outcome after transcatheter AVI. © 2009 European Association for Cardio-Thoracic Surgery. 2010 Journal Article http://hdl.handle.net/20.500.11937/13177 10.1016/j.ejcts.2009.12.025 unknown |
| spellingShingle | Florath, Ines Albert, A. Boening, A. Ennker, I. Ennker, J. Aortic valve replacement in octogenarians: identification of high-risk patients |
| title | Aortic valve replacement in octogenarians: identification of high-risk patients |
| title_full | Aortic valve replacement in octogenarians: identification of high-risk patients |
| title_fullStr | Aortic valve replacement in octogenarians: identification of high-risk patients |
| title_full_unstemmed | Aortic valve replacement in octogenarians: identification of high-risk patients |
| title_short | Aortic valve replacement in octogenarians: identification of high-risk patients |
| title_sort | aortic valve replacement in octogenarians: identification of high-risk patients |
| url | http://hdl.handle.net/20.500.11937/13177 |