Geriatric factors associated with 1-year mortality after aortic valve replacement

Surgical aortic valve replacement has been shown to improve survival and quality of life in patients with severe aortic stenosis. However, clinical variables are known to be associated with an increased mortality rate. As geriatric conditions are highly prevalent in this older population, the aim of this study was to identify geriatric factors associated with 1-year mortality after a surgical aortic valve replacement among older patients with severe symptomatic aortic stenosis.

Between January 2012 and September 2014, all patients ≥ 75 years referred for a surgical aortic valve replacement after a complete pre-operative evaluation in a university-affiliated center were included in this observational study. Association between 1-year mortality surgical aortic valve replacement and baseline characteristics including cardiac and geriatric factors was analysed by Cox models.

Mean age of the 197 patients studied was 81.3 ± 3.5 years and 48.2% were men. At 1 year of the intervention, 19 patients (9.6%) were dead. On multivariate analysis, previous cardiac surgery (Hazard ratio [HR] = 10.47, p = 0.03), undergoing concomitant cardiac surgery (HR = 6.22, p = 0.03), pulmonary hypertension (HR = 3.73, 0.04) were still associated with 1-year mortality. Moreover, cognitive impairment was also associated with 1-year mortality (HR = 4.67, p = 0.04).

This study is the first study to show that among geriatric factors, cognitive impairment was a strong predictor of 1-year mortality after a surgical aortic valve replacement in patients aged 75 years old and older, independently of other geriatric and cardiac factors. This study highlights the importance of pre-operative cognitive assessment.