Early and long-term survival after aortic valve replacement in septuagenarians and octogenarians with severe aortic stenosis

Objective: To evaluate the predictors for mortality following aortic valve replacement (AVR) in elderly patients with aortic stenosis (AS). Methods: 112 consecutive elderly AS patients (aged 77 +/- 2 years) with AVR between 1998 and 2003 were studied. Clinical and echocardiographic data of LV function were recorded before and 46 months after AVR. Results were compared with 72 younger patients (aged 60 +/- 1 years). Outcome measures were 30-day and long-term all cause mortalities. Results: Elderly patients had higher NYHA class, more frequent atrial fibrillation, coronary artery disease, emergency operation and use of bioprosthetic valves. They also had shorter E-wave deceleration time (DT) and larger left atria (p<0.05 for all). 30-day mortality was 12% vs 4% (Log Rank x(2) = 3.02, p = 0.08) and long term mortality was 18% vs 7% (Log Rank x(2) = 4.38, p = 0.04) in two groups respectively. Age was not related to mortality after adjustment for other variables. Among all variables, anemia (OR 4.20, CI: 1.02-6.86, p= 0.04), cardiopulmonary bypass (CPB) time (OR 1.02, CI 1.01-1.04, p<0.01), significant prosthesis patient mismatch (PPM) (OR 5.43, CI 1.04-18.40, p<0.05) were associated with 30-day mortality in elderly patients. Their long-term mortality was related to CBP time (OR 1.02, CI 1.00-1.05, p = 0.04), PPM (OR 4.64, CI 1.33-16.11, p = 0.02) and raised left atrial pressure: DT (OR 0.94, CI 0.84-0.99, p = 0.03) and pulmonary arterial systolic pressure (OR 1.12, CI 1.03-1.19, p<0.001). Conclusion: Peri-operative AVR survival is encouraging. While pre-operative anemia and a longer CBP time determine early mortality, long term mortality is related to PPM, LV diastolic dysfunction and secondary pulmonary hypertension. Crown Copyright (C) 2008 Published by Elsevier Ireland Ltd. All rights reserved.