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Aortic valve replacement in the elderly: a comparative assay of potential risk factor modification
S Chocron1, J P Etievent, J F Viel
1Department of Thoracic and Cardiovascular Surgery, Hopital Saint-Jacques, Besancon, France.
The Journal of Heart Valve Disease
|May 1, 1995
Summary
Advanced age and emergency surgery significantly increase mortality risk after aortic valve replacement for aortic stenosis. Older patients (over 75) and those with pulmonary edema face higher late mortality risks.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Calcified aortic stenosis is a common indication for aortic valve replacement (AVR).
- Advanced age is a growing concern in cardiac surgery populations.
- Predictors of mortality after AVR in elderly patients require further investigation.
Purpose of the Study:
- To evaluate the impact of advanced age on mortality predictors following isolated AVR for calcified aortic stenosis.
- To identify independent predictors of early (hospital) and late mortality in elderly AVR patients.
Main Methods:
- Retrospective study of 208 consecutive patients undergoing isolated AVR for calcified aortic stenosis (1989-1992).
- Analysis of 18 potential mortality predictors using logistic regression (hospital mortality) and Cox proportional hazard models (late mortality).
- Follow-up of 422.5 patient-years to assess survival rates and identify risk factors.
Main Results:
- Hospital mortality was 6.2%. Late mortality rate was 4.5% per patient-year.
- Independent predictors of hospital mortality included age >70 years (OR=9.8) and emergency surgery (OR=8).
- Independent predictors of decreased late survival were age >75 years (RR=3), preoperative acute pulmonary edema (RR=2.9), and emergency surgery (RR=4.2).
Conclusions:
- Advanced age (>70 years) is a significant independent predictor of hospital mortality after AVR.
- Age >75 years, preoperative acute pulmonary edema, and emergency surgery are independently associated with reduced late survival post-AVR.
- While advanced functional class (NYHA III-IV) predicted mortality in univariate analysis, it was not an independent predictor in multivariate models.