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Procedure- and age-specific risk stratification of single aortic valve replacement in elderly patients based on Japan

Nobuhiro Handa1, Hiroaki Miyata, Noboru Motomura

  • 1Department of Cardiovascular Surgery, National Hospital Organization, Nagara Medical Center, Gifu, Japan. handa-kcgh @umin.ac.jp

Circulation Journal : Official Journal of the Japanese Circulation Society
|November 25, 2011
PubMed

Insights

Identifying high-risk patients for single aortic valve replacement (sAVR) is crucial. Elderly patients undergoing sAVR have unique risk factors, including dialysis and respiratory insufficiency, influencing surgical mortality.

Area of Science:

  • Cardiovascular Surgery
  • Geriatric Cardiology
  • Health Services Research

Background:

  • Trans-catheter aortic valve implantation (TAVI) has advanced aortic stenosis treatment.
  • Identifying high-risk surgical candidates for aortic valve replacement remains a challenge.

Purpose of the Study:

  • To assess the risk profile of patients undergoing open single aortic valve replacement (sAVR).
  • To identify specific risk factors for surgical mortality in elderly sAVR patients.

Main Methods:

  • Analysis of 7,883 open sAVR cases from the Japan Cardiovascular Surgery Database.
  • Multiple logistic regression and subgroup analyses by age (<70, 70-79, ≥80 years).

Main Results:

  • Overall sAVR mortality was 3.0%, increasing to 5.2% in the elderly subgroup (≥80 years).
  • Key mortality predictors in all patients included respiratory insufficiency, dialysis, NYHA class III/IV, and reoperation.
  • Elderly patients showed higher risks for dialysis (RR=5.4), respiratory insufficiency (RR=3.3), 3-vessel coronary artery disease (RR=3.6), and emergency surgery (RR=23.1).

Conclusions:

  • Single aortic valve replacement demonstrates good surgical outcomes in Japan.
  • Age-specific analyses reveal a distinct risk profile for elderly sAVR patients in Japan.
Abstract

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