- Research article
- Open Access
- Open Peer Review
Aortic valve replacement in octogenarians
© Bose et al; licensee BioMed Central Ltd. 2007
- Received: 28 January 2007
- Accepted: 13 July 2007
- Published: 13 July 2007
Background and Aims
As our population ages and life expectancy increases the number of people aged over 80 and more referred for cardiac surgery is growing. This study sought to identify the outcome of aortic valve replacement (AVR) in octogenarians.
68 patients aged 80 years or more underwent AVR at the Freeman Hospital, between April 2001 and April 2004. A retrospective review of the notes and outcomes from the patients' GP and the NHS strategic tracking service was performed. 54% (37) underwent isolated AVR whilst 46% (31) underwent combined AVR and CABG.
Follow up was 100% complete. The mean age was 83.1 ± s.d. 2.9 years, a mean gradient of 83 ± s.d. 31 mmHg and mean AVA of 0.56 cm2. The mean additive EuroSCORE was 8.6 ± s.d. 1.2, the logistic EuroSCORE mean 12.0 ± s.d. 5.9. In hospital 30 day mortality was 13 %. Survival was 80% at 1 year and 78% at 2 years. Median follow up was for 712 days. Stepwise logistic regression identified chronic obstructive airways disease as an independent predictor of mortality (p < 0.05). Survival was not adversely affected by the addition of coronary artery bypass grafts to aortic valve replacement, the presence of peripheral vascular disease, hypertension or diabetes. In this study duration of cross clamp or bypass time were not found to reach significance as independent predictors of mortality.
Our study demonstrates that the operative mortality for AVR in the over eighties is good, whilst the mid to long term outcome is excellent There is a very low attrition rate with those undergoing the procedure living as long than their age matched population. This study confirms AVR is a safe, acceptable treatment for octogenarians with excellent mid term outcomes.
- Peripheral Vascular Disease
- Aortic Valve Replacement
- Stepwise Logistic Regression
- Aortic Valve Disease
- Chronic Obstructive Airway Disease
Life expectancy for both men and women has continued to rise in the UK. Data from 2002 shows life expectancy at birth for females born in the UK was 81 years, compared with 76 years for males. This contrasts with 49 and 45 years respectively at the turn of the last century. The expectation of life for people reaching the age of 80 has also increased and is now 7 years for men, 9 years for women in the U.K. (OPCS data). Cardiovascular disease is the largest cause of death in this age group. As our population ages, the number of people aged 80 or over referred for cardiac surgery is increasing with a particular rise in those with aortic valve disease. There is evidence that early outcomes in heart valve surgery are improving over the last decade  Previous studies have demonstrated good outcomes in terms of both operative mortality  and quality of life . Age has also been shown to influence the decision to refer patients with aortic stenosis for surgery  with adverse outcomes . This study sought to identify the medium term outcome of aortic valve replacement in octogenarians in a more recent setting.
Between April 2001 and April 2004 all patients aged 80 years or more who underwent aortic valve replacement (AVR) or AVR and coronary artery bypass grafts at a single tertiary referral hospital in Northern England (Freeman Hospital) were identified. The notes were retrospectively reviewed. The patients' general practices were contacted to obtain follow up data, together with the hospital PATS database and the NHS strategic tracking service. Patients undergoing double valve replacement were excluded.
Demographics, symptoms, risk factors
Mean Age ± s.d. (years)
83.2 ± 2.9
Post operative complications
Renal Support (new CVVH)
Bleeding requiring reopening
The mean additive EuroSCORE was 8.6 ± s.d. 1.2, the mean logistic EuroSCORE was 12.0 ± s.d. 5.9, the mean Parsonnet score was 30.4 ± s.d. 4.3. In hospital 7 day and 30 day mortality were 4.4% and 13% respectively. Isolated AVR mortality was 10% at 30 days. Two patients (3%) were affected by a CVA or TIA. Atrial fibrillation occurred in 18 (26%), whilst seven patients required renal replacement therapy as a new intervention postoperatively in the form of continuous veno-venous haemofiltration. Mean hospital stay was 15 ± s.d. 12 and median 11 days (range 5 to 60 days). See table 2.
This is a small retrospective study which purely looked at hospital morbidity and mortality. Follow up mortality data was collected but there was no assessment of quality of life or symptom status in this data. A selection bias has not been excluded in this group proceeding to surgery. Perhaps because they were so carefully selected median survival was excellent.
My thanks to Linda Fellows and the database managers
- Hellegren L, Kvidal P, Stahle E: Improved early results after heart valve surgery over the last decade. Eur J Cardiothorac Surg. 2002, 22 (6): 904-11. 10.1016/S1010-7940(02)00585-7.View ArticleGoogle Scholar
- Asimakopoulos G, Edwards MB, Taylor KM: Aortic valve replacement in patients 80 years of age and older: survival and cause of death based on 1100 cases: collective results form the UK valve registry. Circulation. 1997, 96: 3403-8.View ArticlePubMedGoogle Scholar
- Khan JH, McElhinney DB, Hall Ts, Merrick SH: Cardiac valve surgery in octogenarians: improving quality of life and functional status. Arch Surg. 1998, 133: 887-93. 10.1001/archsurg.133.8.887.View ArticlePubMedGoogle Scholar
- Bouma BJ, Van der Meulen JH, Van den Brink RB, Arnold AE, Smidts A, Teunter LH, Lie KI, Tijssen JG: Variability in treatment advice for elderly patients with aortic stenosis: a nationwide survey in the Netherlands. Heart. 2001, 85 (2): 196-201. 10.1136/heart.85.2.196.View ArticlePubMedPubMed CentralGoogle Scholar
- Bouma BJ, Van den Brink RB, Van der Meulen JH, Verhaul HA, Cheriex EC, Hamer HP, Dekker E, Lie KI, Tijssen JG: To operate or not on elderly patients with aortic stenosis the decision and its consequences. Heart. 1999, 82 (2): 143-8.View ArticlePubMedPubMed CentralGoogle Scholar
- Keogh B, Klinsman R: Society of Cardiothoracic Surgeons of Great Britain and Ireland. Fifth National Adult Cardiac Surgical Database Report. 2003Google Scholar
- Collart F, Feier H, Kerbaul F, Mouly-Bandini A, Riberi A, Di Stephano E, Seree Y, Mesana TG, Metras D: Primary Valular surgery in octogenarians: perioperative outcome. J Heart Valve Dis. 2005, 14 (2): 238-42.PubMedGoogle Scholar
- Brunvand H, Offstad J, Nitter-Hauge S, Svennevig JL: Coronary artery bypass grafting combined with aortic valve replacement in healthy octogenarians does not increase post operative risk. Scand Cardiovascu J. 2002, 36 (5): 297-301. 10.1080/140174302320774519.View ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.