Survival and quality of life after surgical aortic valve replacement in octogenarians

J Cardiothorac Surg. 2016 Mar 19;11:38. doi: 10.1186/s13019-016-0432-0.

Abstract

Background: In patients with symptomatic severe aortic stenosis, advanced age is often a reason for a transcatheter rather than surgical aortic valve replacement. In this pre-transcatheter cohort we had the unique opportunity to study outcomes after surgical aortic valve replacement for severe aortic stenosis in patients who might currently be triaged to a percutaneous approach.

Methods: In a prospective single-center cohort study we compared the incidence of peri-operative complications, mortality, and health-related quality of life in octogenarians versus patients aged <80 years. The quality of life was measured using the SF-36 questionnaire and expressed as a physical and mental component score (PCS and MCS respectively); a score of 50 equals the average score in the age-matched general population. The association between age and the component scores at one-year follow-up was studied with the use of linear regression, corrected for a set of confounding variables.

Results: We included 762 patients, of whom 21.4 % was aged >80 and 49.0 % underwent concomitant revascularization. In octogenarians, the incidence of post-operative delirium was 11.0 %, which was higher than in patients aged below 80 (6.2 %, p = 0.034); the operative mortality (1.9 % vs. 2.9 %; p = 0.59) and long-term survival were not different however (log-rank p = 0.75). In octogenarians, the quality of life was impaired 30-days after surgery (PCS 45.01, p < 0.001; MCS 48.21, p = 0.04), which improved towards or above normal values at one-year follow-up (PCS: 49.92, p = 0.67, MCS: 52.55, p < 0.001). After correction for confounding, age was not significantly associated with the one-year PCS (β 0.08 per year, p = 0.34) or MCS (β 0.08 per year, p = 0.32).

Conclusions: This pre-transcatheter study showed that surgical aortic valve replacement in octogenarians could be performed with very low mortality, and with a relevant and significant increase of the quality of life towards normal values. Also, age was not associated with a lower PCS or MCS one-year after surgery.

Keywords: Aortic Valve Replacement; Aortic Valve Stenosis; Cardiac Surgery; Elderly; Octogenarian; Quality of Life.

Publication types

  • Observational Study

MeSH terms

  • Age Factors
  • Aged, 80 and over
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / mortality*
  • Aortic Valve Stenosis / surgery*
  • Delirium / epidemiology
  • Female
  • Heart Valve Prosthesis Implantation / mortality*
  • Humans
  • Incidence
  • Male
  • Postoperative Complications / epidemiology
  • Prospective Studies
  • Quality of Life*
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome