Aortic valve replacement in octogenarians: outcome and predictors of complications

We aimed to evaluate the outcome in octogenarians after aortic valve replacement (AVR) and to determine the perioperative parameters that were predictive of a complicated postoperative course.

The study population included 304 patients (65% male) aged 82.7 ± 3.5 years who underwent AVR alone (63%), in combination with coronary artery bypass grafting (28%) or with other procedures (9%), between 1998 and 1/2008. Most patients suffered from combined valve disease.

Mechanical valves were implanted in 50% of the patients. The in-hospital mortality was 5.8%. The stay in the intensive care unit was 2.3 ± 0.5 days and in hospital 15.3 ± 2.6 days. After multivariate analysis we were able to identify some predictors for in-hospital mortality, such as preoperative cardiogenic shock (p<0.02), ejection fraction <0.3 (p<0.03), diameter of prosthesis <21 mm (p<0.05), and redo surgery. The most important predictors for postoperative complications after AVR were preoperative renal failure, additional surgical procedures (i.e. coronary artery bypass, mitral valve) and prolonged aortic crossclamping (all p<0.05).

The outcome after AVR in octogenarians is satisfactory; the operative risk is acceptable and might even be reduced with an individual approach to perioperative management in high-risk patients.